Myocardial Infarction

Question 1

What are the territories of the ECG and arteries?

Answer 1

Question 2

Acute MI management

Answer 2

B – Beta blockers unless contraindicated (cannot use in heart failure or bradycardia)

A – Aspirin 300mg stat dose

T – Ticagrelor 180mg stat dose (clopidogrel 300mg is an alternative)

M – Morphine titrated to control pain

A – Anticoagulant: Low Molecular Weight Heparin (LMWH) at treatment dose (e.g. enoxaparin 1mg/kg twice daily for 2-8 days)

N – Nitrates (e.g. GTN) to relieve coronary artery spasm

S - Streptokinase OR Alteplase (i.e. fibrinolysis) and so PCI within 2 hours OR PCI within 12 hours if they haven’t recieved fibrinolysis

Give oxygen only if their oxygen saturations are dropping (i.e. <94%).

Question 3

MI Complications

Answer 3

Arrythmias

Heart Failure

Acute Pericarditis or Dressler’s Syndrome: usually occurs around 2-3 weeks after an MI. It is caused by a localised immune response and causes pericarditis

Question 4

Long Term Post MI Management

Answer 4

5As

Aspirin 75mg once daily

Another antiplatelet: e.g. clopidogrel or ticagrelor for up to 12 months

Atorvastatin 80mg once daily

ACE inhibitors (e.g. ramipril titrated as tolerated to 10mg once daily)

Atenolol (or other beta blocker titrated as high as tolerated)

Question 5

ST elevation Definition

Answer 5

Increase in height of the T wave in 2 contigious leads which counts as

F: >0.15mV increase in T wave within V2 and V3

M: >0.2mV increase in T wave within V2 and V3

>0.1 mv within any other lead

Question 6

PCI vs Thrombolysis

Answer 6

PCI is better than thrombolysis with alteplase

Do PCI if:

• presenting within less than 12 hours of chest pain starting

AND

• starting PCI would take less than 2 hours longer than starting alteplase would
  (i. e. PCI transfer would take less than 2 hours)