Quesmed Cardiology Flashcards
When is PCI indicated for STEMI?
Patients presenting within 12 hours of symptom onset, ongoing pain/cardiovascular instability.
Transfer time to a facilitity is less than 120 minutes
What is the definitive treatment for STEMI where transfer time is over than 120 minute?
Since PCI is not available, fibrinolytic therapy is ideal to restore coronary blood flow. This should be given with antithrombin at the same time.
ECG should be performed 600-90 minutes post fibrinolytic.
What is Type 2 MI?
Myocardial infarction due to low perfusion from sepsis, hypotension, hypovolaemia or ordinary artery spasm. They d not require the typical conventional treatment.
Which antii-fibrinolytic therapy is used for STEMI?
Streptokinase and alteplase
Which antithrombin drugs are typically used with the anti-fibrinolytic?
Bivalirudin
Dabigatran
What is the management post-acute fibrinolytic?
Aspirin should be offered with a P2Y12 receptor inhibtors like ticagrelor unless they have a high bleeding risk.
Which drug therapy is used for primary PCI?
Clopidogrel with aspirin
Unfractionated heparin for those haemodynamically unstable
What is the loading dose for aspirin?
300mg
What guides the management of a non STEMI?
Risk scoring system should be used to assess the risk f cardiovascular events, such as Qrisk or FRACE.
What is the GRACE score?
Estimate for 6 month mortality based on age, creatinine, abnormal cardiac enzymes and troponin.
How are low risk patients managed with non-STEMI?
Conservative management, which may include ticagrelor with aspirin. Angiography is not necessary unless ischaemia develops.
How are high risk patients managed with non-STEMI?
Immediate angiography and follow on PCI.
Ticagrelor or pasugrel should be offered with aspirin.
During PCI, unfractionated heparin is ideal/
Why would pasugrel be preferred or=ver clopidogrel for management?
Patients that were not previously on anticoauglaton.
What should be given in combination with aspirin for patients with high bleeding risk?
Clopidogrel
What is the long0-term medical management post-MI
Aspirin with clopidogrel or ticagrelor
ACE inhibitor and beta blocker
High dose statin
Echocardiogram to assess systolic function and evidence of heart failrue
What type of infarct increases risk of heart block?
Inferior infarction involving the right coronary artery which supplies SAN.
WHAT IS VENTIRCULAR FREE ALL RUPTRE?
NECROSIS OF VENTIRCULAR WALLS CAN ALLOW RUPTURE AND BLOOD TO ENTER PERICARDIAL SPACE, LEADINGT O TAMPONADE AND CARDIAC ARREST IN SECONDS.
IT HAS AN EXTREMELY POOR PROGNOSIS.
Which type of valvular pathology is common post MI?
Acute mitral regurgitation due to papillary muscle ruputre
What does bradycardia with signs of STEMI indicate
‘
Occlusion of proximal right coronary artery, supplying AV node.
What is a contraindications
What is a contraindication to trombolytic therpay?
Hypertension to reduce the risk of intracranial ahemorrahge
How does stroke affect eligibility of anti-thromboyltic therapy?
Ischaemic stroke must be in the last 3 months to be a contraindication.
Patient presents with chest pain on exertion not relieved by rest and has taken cocaine
Coronary artery vasospasm
Which leads are affected in lateral STEMI?
Lead I, avL and V5-6 will have ST elevation
What is a left ventiruclar aneurysm?
Damage to the left ventircle after a previous STEMI results in an aneurysm, resulting in blood stasis that can lead to thrombus formation and result in ischaemic stork
When is a PCI given for non-STEMI?
Only for haemodynamically unstable patients
What is the most common cause of death in an acute MI?
Ventircular fibrillaiton
What is a requirement for complete heart block?
Infarction of right coronary artery so ST elevation in inferior limb leads.
How does papillary muscle rupture present?
Pan-systolic murmur with pulmonary oedema
What is the reccomended dose for statin as secondary prevention?
80mg for high dose therapy but reduce to 40mg if not tolerated
What is the reccomended dose for statin for primary prevention?
20mg
Which part of the heart does the right coronary artery supply?
Left ventricle inferior and posterior aspect
How do patients present with inter Ventircular septal rupture?
New pan-systolic murmur
Acute heart failure
What is the criteria for contacting the DVLA after an MI?
Left ventiruclar ejection fraction is less than 40% before discharge
Urgent revascularisation within the next 4 weeks
What is a. Valvular complication with ventricualr septal defect?
Acute mitral regurgitation, which is more common in inferno-posterior infarction.
Causes pansystolic mrumur over the apex, and acute left ventiruclar failur
What are the causes of left axis deviation?
Left ventricular hypertrophy
Inferior wall myocardial infarction, as the inferior wall loses an extensive amount of tissue so the heart depolarises away from the inferior leads
How is ventricular septal rupture managed post MI?
Intra-aortic balloon pump
How is pericarditis or Dressler’s syndrome managed?
High dose aspirin post MI
How does pericarditis present? On ECG
Widespread ST elevation, PR depression
AvR will show reciprocal ST depression and pR elevation
What are the reciprocal changes in anterior MI?
ST depression in lead II
What is primary prevention?
Initiating patient on statin for Q risk below 10% which is 20mg
What is secondary prevention?
Dose of statin when patient has already experienced a vascular event, which is 80mg.
How does digoxin affect the ECG?
Downsloping ST depression
How does Dressler’s syndrome present?
Pleuritic chest pain at rest, worse on lying flat
What causes T wave inversion in inferior leads?
Occlusion of right coronary artery so
How does myocarditis present?
Stabbing chest pain, troponin raised and abnromal ECG. No tenderness on palpation
Which marker is importsnt to detect reinfarction?
Creatine kinase-MB found in the myocardium. It has a high rate of clearance and preferred over troponins, whih can be elevated up to 2 weeks post infarction.
What is the initial management for a non-STEMI?
Aspirin 300mg
Clopidogrel 400mg
GTN spray
What is fondaparinux?
Factor X inhibtiors which is an anticoagulant that should be avoided in patients with a bleeding risk.
How. does occlusion of left main coronary artery present?
ST depression in Leads 1, II and V4-6
ST elevation in AVR
Which medication should be added for patinets who have had an acute MI with symptoms of heart failure?
Eplerenone
How do nitrates work?
activate CGMP for vasodilation
