Myocardial Infarction Flashcards
What are the signs and symptoms of an MI?
Chest/back/jaw pain Indigestion Sweatienss / claminess Dyspnoea Tachycardia Distressed patients Heart failure Shock Arrythmia
The release of which protein into the bloodstream is a marker of. cardiac necrosis?
Troponin
Elevated troponin is always an indicator of an MI. T/F?
False - this could be an MI but there are also other causes
Describe type I MI?
Spontaneous MI due to a primary coronary event e.g. coronary plaque rupture and formation of thrombus
Describe type II MI?
Increased oxygen demand or decreased oxygen supply e.g. heart failure, sepsis, anaemia, arrhythmia, hypertension, hypotension
Describe type III MI?
Sudden cardiac death
Describe type 4A MI?
MI associated with percutaneous coronary intervention
Describe type 4B MI?
Mi stent thrombosis documented by angiography or PM
Describe type 5 MI?
MI associated with CABG
What is unstable angina?
An acute coronary event without a rise in troponin
An acute coronary syndrome with ST elevation is indicative of…?
MI
An acute coronary syndrome with no ST elevation but troponin elevation is indicative of…?
MI
An acute coronary syndrome with no ST elevation and no troponin elevation is indicative of…?
Unstable angina
Why is ST elevation not seen with a posterior infarct of the heart?
No ECG leads look directly at the posterior aspect of the heart
Anteroseptal infarcts indicate occlusion of which artery?
Left anterior descending artery
Posterior infarcts indicate occlusion of which artery?
Circumflex artery (sometimes right coronary artery)
Lateral infarcts indicate occlusion of which artery?
Left circumflex artery
What. finding on an ECG indicates a previous MI?
Negative Q wave
Which are the anterior leads of an ECG?
V1,2,3 and 4
An anterior STEMI is shown in the anterior leads. There is also reciprocal ST depression in which leads?
Inferior leads (II, III, aVF)
A high lateral STEMI shows elevation in which leads?
The high lateral leads (I and aVL)
A high lateral STEMI shows elevation in leads I and aVL. This also shows reciprocal ST depression in which leads?
Inferior leads (II, III, aVF)
An inferior STEMI shows ST elevation in the inferior leads (II, II and aVF) and reciprocal ST depression in which leads?
High lateral leads (I and aVL)
How can posterior ST elevation be shown indirectly on an ECG?
Reciprocal ST depression in the anterior leads (V 1,2,3 and 4)
Sometimes subtle ST elevation in inferior leads (II,III and aVF)
What are the indications of a left bundle branch on an ECG>
QRS >120ms and a dominant S wave in V1
What protocol is used for the immediate management of MI?
ABCD protocol
What drugs are given in the immediate management of MI?
300mg Aspirin PO Unfractionated her pain 5000U IV Morphine 5-10mg IV Anti-emetics Clopidogrel if in ambulance and ticagrelor is in hospital
What are the advantages of primary percutanoues coronary intervention when compared to thrombolysis?
Improves survival Reduces trokes Reduces the chance of further MI Reduces the chance of further angina Speeds up recovery and shortens the time spent in hospital
What technique can be used to place a small coronary stent in the immediate management of MI?
Transradial percutaneous intervention
What drugs should be given to all MI patients for the secondary prevention?
ACE inhibitors
Beta blockers
Statins
Aspirin
Which patients should receive eplerenone for secondary prevention of MI?
Diabetes
Left ventricular systolic dysfunction
Clinical heart failure
What are the potential complications of MI?
Arrythmias Heart failure Cardiogenic shock Myocardial rupture Psychological ( anxiety/depression)
Myocardial rupture of the papillary muscle due to MI will cause…?
Mitral regurgitation
How does myocardial rupture of the free wall due to MI lead to death?
By causing cardiac tamponade
Myocardial rupture of the septum due to MI will cause…?
Ventricular septal defect
How is cariogenic shock as a result of MI treated?
Intra-aortic balloon pump
Ventricular assist device
How is heart failure as a complication of MI treated?
Diuretics
Inotropes
Vasodilators
If there is left ventricular dysfunction at >9months after MI then what treatment should be considered?
Implantable cardioverter defibrillator
What risk score system is used to determine which patients get further inpatient care for NSTEMIs?
GRACE risk score
What are the requirements in order for a finding of ST elevation to be significant>
> 1mm in limb leads and >2mm in chest leads
Present in at least two leads
In what situations would oxygen be given for MI?
When the patient is hypoxic (just as with any other condition)
When would thrombolysis be used instead of PCI to reperfuse a STEMI patient?
When for geographical reasons a patient can’t reach a PCI centre in time
