Treatment for acute MI

Question 1

General therapy for MI

Answer 1

MONA+C

• oxygen >90% CLASS I
• aspirin 300mg
• clopidogrel 600mg

Question 2

Anti-emetic you could give with morphine

Answer 2

Metoclopramide

Cyclizine

Question 3

When would you not give a beta-blocker?

Answer 3

signs of heart failure,
evidence of a low output state, 
increased risk for cardiogenic shock, or
relative contraindications to beta blockade
1AVB > 0.24 sec, 
2nd- or 3rd-degree heart block
reactive airway disease

Question 4

When should you give beta blockers for an MI?

Answer 4

Within the first 24 hours

Question 5

PCI time window

Answer 5

Within 90 minutes of MEDICAL CONTACT

Question 6

Fibrinolytic time window

Answer 6

Within 30 min of HOSPITAL PRESENTATION (unless contraindicated)

Question 7

What kind of bolus of Reteplase would you give?

Answer 7

double bolus

Question 8

Contraindications to thrombolysis

Answer 8

Recent surgery, recent trauma or head injury, bleeding diatheses, coma, active peptic ulcer, recent stroke, suspected aortic dissection, traumatic resuscitation attempt, allergy to streptokinase (for streptokinase but alternative can be given) etc. Severe hypertension – control the blood pressure first eg with GTN then proceed.

Question 9

Thromboylsis and severe high blood pressure?

Answer 9

Control high blood pressure first before you commence with thrombolysis (control with GTN)

Question 10

Streptokinase side effects

Answer 10

nausea, hypotension, allergy, bleeding, reperfusion arrhythmias

Question 11

tPA (alteplase) side effects

Answer 11

Bleeding, Reperfusion arrhythmias

Question 12

Opiate side effects

Answer 12

sedation, hypoventilation, nausea

Question 13

High flow oxygen side effects

Answer 13

Type II respiratory failure

Question 14

Beta blocker side effects

Answer 14

bradycardia, cardiac failure, bronchospasm in asthma & chronic bronchitis, hypotension

Question 15

Treatment for ischaemic VT?

Answer 15

DCCV, cath lab (if needed), electrolyte correction, amiodarone, lidocaine, beta-blockers

Question 16

Complications of MI

Answer 16

Arrhythmias
Ventricular Septal Perforation
Ischemic Mitral Regurgitation, Papillary Muscle Rupture
Ventricular Free Wall Rupture
Systemic Embolism 
Ventricular Aneurysm
Pericarditis
Cardiogenic Shock

Question 17

Cardiogenic shock/pulmonary oedema and MI treatment?

Answer 17

MONA - Morphine, Oxygen, Aspirin
No nitrates because hypotensive
No beta-blocker b/c in heart failure
IV frusemide
I.V. Inotropic agents:
Dobutamine / Dopamine
Intra-aortic balloon pump

Question 18

Secondary prevention following MI

Answer 18

• Physical activity for 20-30mins a day
• Quit smoking
• Mediterranean style diet
• 2-4 portions of oily fish per week (if they can’t achieve this: 1g of daily omega-3 acid for secondary prevention up to 4 years)

Question 19

When should aspirin and clopidogrel be prescribed?

Answer 19

• after an NSTEMI

- after PCI and stents

Question 20

Drug therapy for all when ya are going home

Answer 20

All patients who have had an acute MI should be offered treatment with the following drugs:

• ACE (angiotensin-converting enzyme) inhibitor
• aspirin
• beta-blocker
• statin

Question 21

Drug therapy: aldosterone antagonists following MI

Answer 21

Patients with symptoms and signs of heart failure will require an early assessment of LV function.
Those with symptoms or signs of heart failure and LVSD should be offered a licensed aldosterone antagonist within 3–14 days of the acute MI