Q and A

Question 1

STEMI Criteria

Answer 1

1 mm or more in ALL leads except V2-V3
1. 2.5 mm or more for < 40 years old male
2. 2 mm or more for > 40 years old male
3. 1.5 mm or more for women of ALL ages

Question 2

Areas of infarction and vessel involved

Answer 2

Anterior: V1-4 ST elevation; LADA
Posterior: V1-V3 ST depression, large R wave; Proximal RCA, left circumflex
Inferior: II, III, aVF ST elevation; RCA, left circumflex
Lateral: I, aVL, V5-V6 ST elevation; left circumflex
Right ventricular: II, III, aVF and V1 ST elevation; III greater than II, large R wave in V4; Proximal RCA

Question 3

Key to management of RV failure

Answer 3

Careful monitoring of fluid status

Question 4

Characteristic clinical findings in RV MI

Answer 4

Low cardiac output with jugular venous distension but no pulmonary congestion

Question 5

ECG findings of LMCA occlusion

Answer 5

ST depression in I, II, V4-V6
ST elevation of 1 mm or more on aVR
ST elevation of aVR > or = V1

Question 6

WHO criteria for diagnosing acute MI

Answer 6

At least 2 out of 3:
1. History of chest pain characteristic of cardiac ischemia
2. Evolutionary ECG changes
3. Rise or fall of cardiac biomarkers

Question 7

Coronary artery occlusion with highest incidence of AV nodal block

Answer 7

Proximal RCA due to involvement of AV intranodal artery and right superior descending artery

Question 8

Management of NSTEMI

Answer 8

Dual antiplatelet
Anticoagulant
Anti-ischemic

Question 9

Thrombolytic with minimum risk of causing hemorrhagic stroke

Answer 9

Streptokinase

Question 10

How do you administer Reteplase?

Answer 10

Two IV bolus, 30 minutes apart

Question 11

How do you administer Alteplase?

Answer 11

Standard: One IV bolus followed by five infusions
Accelerated: One IV bolus followed by two infusions

Question 12

Thrombolytic with longest patency rate

Answer 12

Reteplase

Question 13

Which thrombolytics are administered with heparin and which are not?

Answer 13

With: Reteplase and alteplase
Without: Streptokinase

Question 15

Describe the different cardiac biomarkers (Onset, peak and return to normal)

Answer 15

Myoglobin: 1-4 hrs, 6-7 hrs, 24 hrs
Trop-I: 3-12 hrs, 24 hrs, 5-10 days
Trop-T: 3-12 hrs, 12 hrs - 2 days, 5-14 days
CK-MB: 3-12 hrs, 24 hrs, 2-3 days
LDH: 10 hrs, 24-48 hrs, 10-14 days

Question 16

Medications most likely to prolong survival after an MI

Answer 16

1. ACE
2. Statin
3. Aspirin
4. BB

Question 17

Which papillary muscle commonly ruptures after MI?

Answer 17

Posteromedial due to single arterial supply (RCA)
Anterolateral: LAD and LCA

Question 18

Most critical of the myocardial blood supply

Answer 18

LADA