Myocardial Infarction

Question 1

What are the diagnostic criteria for MI?

Answer 1

Rise and/ or fall in troponin with at least one value >99th percentile of the URL and one of:
Symptoms of ischaemia
ECG changes
Imaging evidence of new loss of viable myocardium

Question 2

What are the two types of MI?

Answer 2

STEMI- occlusive thrombus. NSTEMI- subocclusive thrombus

Question 3

What are features of ischaemic myocardial injury? (6)

Answer 3

Chest pain, 4th heart sound, low grade fever, troponin lean, leukocytosis, autonomic disturbance

Question 4

How to prevent pre hospital death from MI?

Answer 4

Defib for VF

Question 5

How to prevent death from MI in hospital?

Answer 5

Reperfusion therapy to prevent death from HF

Question 6

How to prevent late deaths from MI?

Answer 6

Recurrent events- secondary prevention. Lethal arrhythmias- implantable defib

Question 7

Treatment of STEMI- antiplatelet drugs?

Answer 7

Aspirin and ticagrelor

Question 8

Other drugs to treat STEMI?

Answer 8

tPA activator and LMWH

Question 9

NSTEMI treatment- antiplatelet drugs?

Answer 9

Aspirin, ticagrelor, +-Gp2b/3a inhibitor

Question 10

Other drugs for NSTEMI?

Answer 10

Fondaparinux, beta blockers, nitrates

Question 11

Risk assessment of NSTEMI?

Answer 11

GRACE score

Question 12

Secondary prevention of MI?

Answer 12

Lifestyle advice. Aspirin, clopidogrel, statin, ACEI, BBs

Question 13

What are some indications for an implantable defib as secondary prevention? (3)

Answer 13

Late CA VT/VF. Sustained VT with syncope. Sustained VT and LVEF <35%