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► Med - Anatomy & Physiology > Myocardial Infarction > Flashcards

Myocardial Infarction Flashcards

1
Q

What is an acute coronary syndrome?

A

Any acute presentation of coronary artery disease

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2
Q

What are the two types of MI?

A

ST elevation MI - STEMI

Non ST elevation MI - NSTEMI

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3
Q

Give three acute coronary syndromes?

A
  1. Unstable angina
  2. MI sudden
  3. Cardiac death
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4
Q

Give 3 features of acute coronary syndrome?

A
  1. Dynamic stenosis
  2. Supply led ischaemia
  3. Unpredictable/dangerous
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5
Q

How is thromboxane A2 generated?

A

Via cyclooxygenase from platelet membrane lipids

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6
Q

What do both ADP and thromboxane A2 do to platelets?

A

Cause further activation and recruitment

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7
Q

What type of angina has fixed stenosis, demnad led ischaemia and is predictable/safe?

A

Chronic stable angina

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8
Q

What part of the plaetelt cascade involves unactivated platelets rapidly being recruited and adhering to the site of vascular damage, forming a monolayer?

A

Adhesion

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9
Q

During release of activators in the platelet cascade, what is released from platelet dense granules?

A

ADP

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10
Q

What does platelet activation accelerate?

A

Platelet aggregation

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11
Q

Activation of platelets trigger the inflammatory cascade, what do activated platelets express for leukocytes?

A

Adhesion receptors

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12
Q

Name two platelet sufacr inflammatory markers?

A

CD40L and P-selectin

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13
Q

What platelet leukocyte conjugates, forming via P-selectin interact with?

A

Its ligand PSGL-1 on leukocyte surface

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14
Q

What three things does CD40L interact with?

A

Monocytes, endothelial cells and smooth muscle cells

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15
Q

What condition is prolonged, and not relieved by GTN, it is associated with sweating nausea an often vomiting?

A

MI

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16
Q

What ivestigation is used to diagnose STEMI?

A

ECG

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17
Q

What three ECG changes are seen in acute ST elevation myocardial infarction?

A
  1. ST elevation
  2. T wave inversion
  3. Q waves
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18
Q

What ECG change is seen after the first few hours of an acute MI?

A

ST elevation

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19
Q

What ECG change is seen after the first day of an acute MI?

A

Q wave formation and T wave inversion

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20
Q

What ECG changges are seen in an old MI?

A

Q waves +/- inverted T waves

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21
Q

What are the three features for confirming diagnosis of a STEMI on an ECG?

A
  1. > 1mm ST elevation in 2 adjacent limb leads
  2. > 2mm ST elevation in at least 2 contiguous precordial leads
  3. New onset bundle branch block
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22
Q

What are the leads for an inferior MI?

A

II, III, AVF

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23
Q

What are the leads for an anteroseptal MI?

A

V1-V4

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24
Q

What are the leads for an anterolateral MI?

A

I, AvL, V1-6

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25
Q

Could cardiac enzymes and protein markers for an MI be normal at presentation?

A

Yes

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26
Q

What 2 substances would you look for when diagnosing an MI?

A

Creatinine Kinase - CK

TnT - troponin T

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27
Q

When does creatinine kinase peak after an MI, and where is it also found?

A

Peaks in 24 hours

Found in skeletal muscle and brain

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28
Q

What substance can detect tiny amounts of myocardial necrosis and is hughly specific for cardiac muscle damage?

A

TnT

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29
Q

What are the 7 treatments for early treatment of a STEMI?

A
  1. Analgesia - dimorphine IV
  2. Anti-emetic - IV
  3. Aspirin - 300mg and Clopidogrel 300mg
  4. GTN if BP>90mmHg
  5. Oxygen - if hypoxic
  6. Primary angioplasy
  7. Thrombolysis - if angioplast is not available within 90 minutes
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30
Q

How does Aspirin work?

A

Inhibits COX preventing the production of prostaglandin and thromboxane A2 fro arachidonic acid.

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31
Q

What does TXA2 aid the expression of, allowing fibrinogen to bind?

A

GP IIb/IIIa binding site on the platelet, allowing fibrinogen to bind

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32
Q

How does Clopidogrel work?

A

It is a potent inhibitor of ADP-induced platelet aggregation, irreversibly inhibiting the binding of ADP to its platelet membrane receptors.

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33
Q

In addition to long term aspirin, what should be continued for up to four weeks in patients with ST elevation acute coronary syndrome?

A

Clopidogrel

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34
Q

Give two reperfusing therapies?

A
  1. Thrombolysis

2. PCI

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35
Q

What are the two indications for reperfusion therapy (thrombolysis or PCI)?

A
  1. Chest pain suggestive of acute MI - more than 20 minutes less than 12 hours
  2. ECG changes - acute ST elevation, new LBBB
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36
Q

Name an arrhythmic complication of an MI?

A

Ventricular fibrillation

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37
Q

Give three structural complications of an MI?

A
  1. Cardiac rupture
  2. Ventricular septal defect
  3. Mitral valve regurgitation
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38
Q

What are left ventricular aneurysm formation, mural thrombus (+/- systemic emboli), inflammation, acute pericarditis and Dressler’s syndrome?

A

Structural complications of an MI

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39
Q

Give three functional complications of an MI?

A
  1. Acute ventricular failure
  2. Chronic cardiac failure
  3. Cardiogenic shock
40
Q

What is the killip classification of in-hospital mortality?

A

I - no signs of heart faILURE 6%
II - crepitations 50% of lung fields 38%
IV - cardiogenic shock 81%

41
Q

In ACS with unstable angina, what can be said about the marker, ECG and LV function?

A

Marker: Tn & CK-MB undetectable
ECG: ST decreased or T decreased or transient ST increase or normal
LV function: no measurable dysfunction

42
Q

What can be said about markers in ACS with myocyte necrosis?

A

Troponin elevated

TnT

43
Q

What can be said about markers, ECG, pathology and LV function of ACS with clinical MI?

A

Markers: TnT > 1.0 +/- CK-MB increased, or AccuTn > 0.5
ECG: ST increased or ST decreased or T wave inversion, may evolve Q waves
Pathology: complete coronary occlusion
LV function: systolic dysfunction, LV dilatation

44
Q

What is raised in CCF, hypertension, renal failure, PE, sepsis, stroke/TIA, pericarditis/myocarditis and post arrhythmia?

A

TnT

45
Q

What is the final common pathway to platelet aggregation?

A

GP IIb-IIIa

46
Q

What should patients with non-ST elevation ACS at medium or high risk of early recurrent CVS events undergo?

A

Early coronary angiography and revascularisation

47
Q

What is another term for congestive cardiac failure (CCF)?

A

Heart failure

48
Q

What is heart failure due to in most cases?

A

Low cardiac output

49
Q

What are the signs and symptoms of heart failure due to?

A

Fluid retention

50
Q

What three conditions are a result of Left sided heart failure?

A
  1. IHD = MIs
  2. Cardiomyopathy
  3. Valvular disease
51
Q

What two conditions are a result of right heart failure?

A
  1. Cor pulmonale

2. Congenital heart disease

52
Q

Give 4 symptoms of left heart failure?

A
  1. Dyspnoea on exertion
  2. Orthopnoea
  3. Paroxysmal nocturnal dyspnoea
  4. Pulmonary oedema (pink, frothy sputum)
53
Q

What is a gallop rythm?

A

S3 + tachycardia

54
Q

Give 4 signs of left ventricular failure?

A
  1. Tachycardia
  2. Fine crepitiations
  3. Pleural effusion
  4. S3
55
Q

What is a symptom of right heart failure?

A

Oedema

56
Q

What are three signs of right heart failure?

A
  1. JVP elevated
  2. Hepatomegaly
  3. Ascites
57
Q

What is the CXR like with right heart failure?

A

Normla

58
Q

What are the two treatments for Cor Pulmonale?

A
  1. Diuretics

2. Oxygen

59
Q

What is the treatment for valvular disease?

A

Surgery

60
Q

What is the treatment for fast AF?

A

Digoxin or DC shock

61
Q

What two conditions would you start standard medical therapy for CCF?

A

Previous MIs

Cardiomyopathies

62
Q

What are the 4 main drugs used in standard medical treatment for CCF?

A
  1. Diuretics - excrete retained fluid
  2. ACE inhibitors
  3. Beta blockers
  4. Spironolactone (severe cases only)
63
Q

What are two lesser used drugs for Standard medical treatment for CCF?

A
  1. Digoxin

2. Other vasodilators (nitrates, hydralazine)

64
Q

What are three non pharmacological treatments (standard medical for CCF)?

A
  1. Implantable cardiac defibrillators
  2. Cardiac resynchronisation therapy
  3. Transplantation
65
Q

What diuretics are used for mild CCF?

A

Thiazide diuretics

66
Q

What two coincidental drugs help retain and normalise K?

A

ACE inhibitors and spironolactone

67
Q

What are captopril, enalapril and lisinopril?

A

ACE inhibitors

68
Q

What are three side effects of ACE inhibitors?

A
  1. Angioneurotic oedema
  2. First dose hypertension (esp if serum Na low)
  3. Renal impairment - UE must be monitored after ACE inhibiters start)
69
Q

What are losartan and valsartan?

A

ARBs

70
Q

What is a beta-1 selective beta-blocker?

A

Bisoprolol

71
Q

What is a non-selective plus alpha blockade beta-blocker?

A

Carvedilol

72
Q

What are hypotension nad worsening dysponoea two initial risks of?

A

Beta-blockers

73
Q

Name an aldosterone receptor antagonist used in severe CCF?

A

Spironolactone

74
Q

Give three side effects of spironolactone?

A
  1. Hyperkalaemia
  2. Renal dysfunction
  3. Gynaecomastia
75
Q

What drug slows heart rate but should only be used if HR is fast, despite beta-blockers?

A

Ivabradine

76
Q

What is used only for prolonged QRS and involves 3 pacemakers inserted to force LV and RV to contract together?

A

Cardiac Resynchronisation Therapy

77
Q

What drug is excreted slowly by kidneys and has a narrow therapeutic window?

A

Digoxin

78
Q

What is digoxin used for?

A

AF but mediocre therapy for CCF in sinus rhythm

79
Q

What are nausea, vomiting, bradycardia, heart block, arrythmia (VT, PAT) all side effects of?

A

Digoxin

80
Q

4 management steps in acute LVF.

A
  1. Sit up
  2. Oxygen
  3. IV furosemide
  4. IV diamorphine - not in COPD
81
Q

What condition should diuretics not be used in?

A

Gout

82
Q

What is general therapy for an MI (MONA + C)?

A

Morphine (plus anti-emetic i.e. metoclopramide or cyclizine)
Oxygen (pulse ox>90% classI)
Nitroglycerin (SL GTN x 3 for iscaemic pain)
Aspirin 300mg + clopidogrel 600mg

83
Q

How should aspirin be taken in pateints who have not taken aspirin vefore presentation with STEMI?

A

Chewed

84
Q

What theraoy should be initiated in the first 24 hours for patients who do not have signs of heart failure, evidence of low output state, increased risk for cardiogenic shock or relative contraindications ro beta-blockade?

A

Betablockers

85
Q

How fast should STEMI patients presenting to a hospital with PCI capability be treated with primary PCI?

A

Within 90 minutes

86
Q

What therapy should STEMI patients presenting to a hospital without PCI capability, and who cannot be transfered to a PCI center and undergo PCI within 90 minutes of first medical contact get?

A

Fibrolytic therapy within 30 minutes

87
Q

What are three opiate side effects?

A

Sedation, hypoventilation and nausea

88
Q

After an MI, how often should patients be active for a day?

A

20 - 30 minutes

89
Q

All patients who have had an acute MI should receive what 4 drugs?

A

Statin
ACE inhibitor
Beta-blocker
Aspirin

90
Q

What combination of drugs should be given after non-ST-segment elevation MI?

A

Aspirin and Clopidogrel

91
Q

For post MI patients with symptoms or signs of heart failure and LVSD what should they be offered and within how long of the acute MI?

A

Aldosterone antagonist within 3-14 days of an acure MO

92
Q

Would recent aggresive CPR contraindicate thrombolytic therapy?

A

Yes

93
Q

Is there risk of systemic embolism with AF?

A

Yes

94
Q

What is the characteristic ECG sign of myocardial ischaemia?

A

The development of ST segment depression on exercise

95
Q

What does the ECG in complete 3rd degree heart block show?

A

Dissociated ventricular and atrial activity

96
Q

Can drug therapy cause VT?

A

Yes

► Med - Anatomy & Physiology (130 decks)

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