Myocardial Infarction/Cardiac Arrest

Question 1

What are the contraindications for thrombolysis?

Answer 1

• Recent surgery, trauma or head injury • Suspected aortic dissection or stroke • Allergy to streptokinase • Severe hypertension in which you would

Question 2

Which cardiac troponin are sensitive for acute MI?

Answer 2

Troponin I and T

Question 3

True or False: You would treat an NSTEMI similarly to STEMI ie. MONA+C

Answer 3

True

Question 4

What is the pharmacological management for acute heart failure?

Answer 4

LMNOP: - Loop diuretics (e.g. furosemide) – to clear the fluid from her lungs - Morphine - Nitroglycerin - Oxygen - Position – get them to sit up

Question 5

Chronic stable angina

Answer 5

There is a fixed stenosis which is entirely predictable and safe, and is caused by demand led ischaemiathere is a fixed stenosis which is entirely predictable and safe, and is caused by demand led ischaemia

Question 6

Acute coronary syndrome

Answer 6

Any acute presentation of coronary artery disease. Includes unstable angina, NSTEMI and STEMI

Question 7

True or False: Stable angina is supply led ischaemia

Answer 7

False, it is demand led ischaemia (on exertion)

Question 8

True or False: ACS is supply led ischaemia

Answer 8

True, it is unpredictable and can be on rest

Question 9

What is the difference in the pathophysiology of an NSTEMI and a STEMI?

Answer 9

NSTEMI occurs by developing a complete occlusion of a minor coronary artery or a partial occlusion of a major coronary artery previously affected by atherosclerosis. This causes a partial thickness damage of heart muscle. STEMI occurs by developing a complete occlusion of a major coronary artery previously affected by atherosclerosis. This causes a full thickness damage of heart muscle.

Question 10

**What are the clinical findings of NSTEMI on ECG?

Answer 10

ST-segment depression or T-wave inversion

Question 11

**What are the clinical findings of STEMI on ECG?

Answer 11

ST segment elevation in ECG in first few hours, and pathological Q-wave and T-wave inverse in first few days

Question 12

Levine Sign

Answer 12

Clenched fist over chest

Question 13

**In terms of history, how do you differentiate angina from MI?

Answer 13

.

Question 14

Which leads indicate an inferior MI?

Answer 14

II, III, AVF

Question 15

Which leads indicate an anterior MI?

Answer 15

V1-6

Question 16

Which leads indicate an anteroseptal MI?

Answer 16

V1-V4

Question 17

Which leads indicate an anterolateral MI?

Answer 17

I, avL, V1-V6

Question 18

What are the complications of MI?

Answer 18

D - death A - Arrhythmia R - Rupture (free ventricular wall/ ventricular septum/ papillary muscles) T - Tamponade H- Heart failure (acute or chronic) V- Valve disease A - Aneurysm of ventricle D - Dressler’s syndrome E - Embolism (mural thrombus) R - Recurrence

Question 19

Cardiac arrest

Answer 19

Cessation of the heart (meaning no circulation and therefore no oxygen delivery)

Question 20

What is the target time of defibrillation with cardiac arrest?

Answer 20

Within 3 mins

Question 21

What is the chain of survival?

Answer 21

1) Early recognition and call for help to prevent cardiac arrest 2) Early CPR to buy time 3) Early defibrillation to restart the heart 4) Post rests care to restore quality of life

Question 22

What are the main causes of cardiac arrest generally associated with?

Answer 22

Airway, breathing and circulation - i.e., oxygen delivery problems. Including low SaO2, low Hb, HR, low BP

Question 23

Which intervention can you do to increase preload for treatment of cardiac arrest?

Answer 23

IV fluids and raise legs

Question 24

**What are the differences between asleep, unconscious, respiratory arrest and cardiac arrest?

Answer 24

.

Question 25

**What is the management for the different categories of patients in terms of basic life support?

Answer 25

.

Question 26

To what depth should chest compressions be?

Answer 26

5-6 cm

Question 27

At what rate should chest compressions be given?

Answer 27

100-120 per minute

Question 28

At what ratio should compressions: rescue breathes be given?

Answer 28

30:2

Question 29

Which cardiac rhythms are shockable?

Answer 29

Ventricular fibrillation and ventricular tachycardia

Question 30

Which cardiac rhythms are non-shockable?

Answer 30

Asystole/ Pulseless electrical activity

Question 31

Defibrillation

Answer 31

Use of electrical current to “reset” heart electrical rhythm with hope that regular rhythm will recur.

Question 32

What is the management of asystole?

Answer 32

Adrenaline 1 mg IV as soon as possible (every 3 – 5 min thereafter (every 2 cycles))

Question 33

**What are the main reversible factors contributing to cardiac arrest, and how would you treat each of these?

Answer 33

4 H’s and 4 T’s:

• Hypoxia
• Hypovolaemia
• Hypo-/hyperkalaemia/metabolic
• Hypothermia
• Thrombosis - coronary or pulmonary
• Tension pneumothorax
• Tamponade - cardiac
• Toxins

Question 34

What does Post-Cardiac Arrest Syndrome involve?

Answer 34

1. Post-cardiac arrest brain injury 2. Post-cardiac arrest myocardial dysfunction 3. Systemic ischaemia / reperfusion response 4. Persistent precipitating pathology

Question 35

Which 2 enzyme markers can be used to identify MI?

Answer 35

Troponin (released from myocytes when irreversible myocardial damage occurs) and creatinine kinase