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Clinical Exercise Prescription > Myocardial Infarction > Flashcards

Myocardial Infarction Flashcards

1
Q

chain of events leading to an MI

A 
atherosclerosis 
plaque rupture 
platlet aggregation
thrombus formation 
vessel occlusion 
vasospasm 
distal ischemia 
ischemic complications
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2
Q

classic symptoms of an MI

A

intense opressive chest pain/pressure radiating to left arm

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3
Q

other symptoms of MI

A 
increased chest heaviness 
nausea 
dyspona
ligthheadness
sweating 
confusion
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4
Q

characteristics of a stable angina

A

transient (<30mins) episodic chest discomfort
predictable, reproducible
often follows physical excertion or emotional stress

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5
Q

ECG of stable angina

A

normal,
t wave changes
st depression

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6
Q

unstable angina

A

new onset
rest angina
angine worseing in severity or occuring with PA

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7
Q

ischemic ECG

A

assocaited with inverted t wave or st segment depression

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8
Q

Non-STEMI ECG

A

partial or intermittent blockage of the artery, may show ST depression

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9
Q

STEMI ECG

A

St segment elevation and t wave inversion

casued by complete and perishing blockage of the artery

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10
Q

how does ischemia reduce ATP availibilty

A

K+ channels open if Low ATP, thus K+ quickly leak out of cell = trigger deploarization
Ca and Na flood inwards
reduced K:Na pump activity
K builds up outisde, reducing gradient
cell stays positve for longer before repolarzing

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11
Q

effect MI on ST

A

depression
depolarises, ischemic region generates electrical current
pocket of +ive signal elevates baseline volatge
when ventricles become depolarized, all the muscle depolarises so 0 voltage is recorded
ST segment appears depresssed relative to baseline

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12
Q

potential charactersitics of ST depression

A 
downsloping 
upsloping 
horizontal 
need to be >1mm below baseline 
seen in at least 2 leads
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13
Q

effect of MI Q wave

A

damage to left ventricle

dead area so no signal

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14
Q

non pathological q wave

A

q wave less than 2mm are normal

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15
Q

pathological q wave

A

q wave greater than 2mm

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16
Q

marker of historic heart attcak

A

deeper q wave

due to damage in the tissue

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17
Q

surivival of MI

A

60min golden window

irreversible injury typically requires 30 mins of ischemia

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18
Q

use of cardiac enzymes

A

allow clincians to document when hearrt attack started as each spike at different times
released when myocardial tissue dies causing cells to collapse and spill contents into blood

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19
Q

CPK peak and time

A

12-36 hours

raise 3-4 d

20
Q

tropoin peak

A

peak 12-24

approx 8

21
Q

anti- ischemics

A

oxygen
beta-blockers - slow HR, reduced O2 requirement
nitrates - vasodilator
morphine - pain relief

22
Q

anti thrombotics

A

anti platelet agents

- tissue plasminogen activator

23
Q

Post myocardial infarction

first 4-6 hours

A

poor contraction

loses systolic power

24
Q

Post myocardial infarction

7 days

A

infarct dilation and remodling
inflammation
bruising
thinning of ventricles and enlargement of infarct site

25
Q

Post myocardial infarction

6-12 weeks

A

necrosis may develop congestive heart failure
scarring
- scar tissue leads to increased stiffness
- partially resolves with time

26
Q

types of blood thinners

A

asprin plus another antiplatelet therapy (warfrin)

novel oral anti-coagulents

27
Q

effect of ACE Inhibitors

A

decrease peripheral resistance = reduce BP and less heart work
aids fibrin disolving

28
Q

effect of Beta blockers

A

reduce heart work

adrenaline, epinephrin blocker

29
Q

effect of statins

A

cholestrol lowering

30
Q

effect of calcium channel blockers

A

decrease peripheral resistance = less heart work

31
Q

effects of diruetics

A

reduce blood volume = reduces BP & heart work

32
Q

aspects of a comprehensive cardiac rehab programme

A 
exercise training 
psychological and stress counselling 
dietary advice 
advice on meds and treatment 
risk factor modification 
facilitating social reintegration
33
Q

benefits of exercise based cardiac rehab

A 
13-26% decrease in all cause mortality 
10-36% decrease in cardiac mortality 
20-50% decrease in reinfarction 
10% risk decrease cardiac mortality 
23-56% decrease in hopital readmission 
cost effective 
increase QoL
34
Q

starting rehab

A

normally met in hospital
Post MI/PTCA rehab starts 2-4 weeks later
Post CABG - rehab starts 4-6 weeks

35
Q

rehab stage 1

A

before discharge from hospital

  • assessment
  • lifestyle advice
  • medication
  • informative
36
Q

rehab stage 2

A

early post discharge

  • comperhensive assesment
  • education
37
Q

rehab stage 3

A

strucural exercise

maintain access to advice and support

38
Q

rehab phase 4

A

long term maintenance

  • long term advice
  • referal onto other groups
  • outside exercise
39
Q

what is the best single measure of an individuals Cadio respiratory fitness

A

peak oxygen uptake

40
Q

VO2 equation

A

VO2 = Q xA - VO2 Diff

41
Q

peak vo2 of aerobically fit vs unfit

A

unfit is lower

42
Q

peak vo2 of cardiac patient

A

CAD patients may have 50% lower peak VO2

43
Q

stroke volume cardiac patients

A

increases with exercise
levels off at 50% peak vo2
dictated by venous return, TPR and myocardial contractility

44
Q

why does SV decrease

A 
scarring and ischemia 
- increases wall stiffness
- hypokinectic myocardium
decrease EDV 
decrease contractility - increase afterload 
decrease SV
45
Q

why does Q decrease

A

coronary vasoconstriction
- exercise can cause locailised vasocon
reduces blood supply to myocardium making it hypokinetic
- subnormal production of endotheliam NO
- localised overproduction of endothelium

46
Q

redistrubution in cardiac patients

A 
do not redistrubute as effectively 
viseral blood flow as % resting value 
- normal 20%
- cardiac 50%
therefore less delivered to the muscles

Clinical Exercise Prescription (12 decks)

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