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JG Year 2 > 206 MI > Flashcards

206 MI Flashcards

1
Q

What cause the myocardial damage in an NSTEMI?

A

Prolonged myocardial ischaemia

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2
Q

Name the cardiac enzymes measured when investigating ACS

A

CK
Troponin
AST (aspartate aminotransferase)
LDH (lactic dehydrogenase)

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3
Q

What is the most likely diagnosis if the cardiac enzymes are not raised after a ?ACS ?

A

Unstable angina

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4
Q

What is the initial treatment of ACS?

A 
IV access
Streptokinase 1.5M units per 100ml NaCl (0.9%)
Analgesia - diamorphine 2.5mg
Aspirin 300mg
Bloods - incl cardiac enzymes
ECG
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5
Q

What is a type A aortic dissection?

A

Dissection in the root within the pericardium - chambers - requires surgery

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6
Q

What is a type B aortic dissection?

A

Dissection in the arch and beyond - manage the BP here

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7
Q

What are the symptoms of a pericardial effusion?

A

Flu-like symptoms, chest pain, SOB

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8
Q

Name 4 DDx for chest pain (6 listed)

A
  1. Acute aortic dissection
  2. MI
  3. Acute pericarditis
  4. Acute PE
  5. PnTx
  6. Referred pain
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9
Q

What is the treatment for a STEMI?

A

Bolus thrombolytics

Cath lab for PCI (give clopidogrel + abciximab)

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10
Q

What are the options for restoration of flow in NSTEMI?

4 listed

A
  1. Primary angioplasty
  2. Thrombolysis
  3. Nitrates
  4. CABG
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11
Q

Which drugs are used in the future prevention of an MI following a recent MI?
(MI-5)

A 
Aspirin
ACEI (ramipril)
B-Blocker (e.g. bisoprolol)
Clopidogrel
Statin
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12
Q

What is the MOA of ramipril?

A

ACE inhibitor - affecting the RAAS promoting Na and H20 retention.

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13
Q

What is the MOA of simvastatin?

A

Inhibits HMG CoA reductase (involved in cholesterol synthesis) therefore decrease in LDL

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14
Q

What is the MOA of clopidogrel?

A

Pro drug (converted by CYP enzymes) - irreversibly blocks P2Y12 components of adenosine receptors on platelet surface

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15
Q

Which 2 drugs are used as dual antiplatelet therapy post PCI?

A

Aspirin and clopidogrel

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16
Q

What is the MOA of bisoprolol

A

B blocker - decreases sympathetic drive + HR + myocardial contractility
It selectively blocks catecholamine stimulation of β1-adrenergic receptors in the heart and vascular smooth muscle.

17
Q

What is Losartan + its MOA?

A

ARB - angiotensin II receptor blocker.

Blocks vasoconstriction properties of aldosterone release - for people with low tolerance to ACEI

18
Q

What does the TIMI score predict?

A

35 day risk of further event post MI

19
Q

What does the GRACE score predict?

A

All cause mortality in hospital at 6 months post MI

20
Q

What’s the arrhythmic complication of an MI?

A

VF ( risk greatest in the 1st hour)

21
Q

What are the mechanical complications of MI?

A

Scarring of muscle –> cardiac tamponade

Damage to papillary muscle = regurge + pulmonary oedema

22
Q

In which layer of the arterial wall do atherosclerotic plaques develop?

A

Tunica intima

23
Q

What is the step which initiates development of an artherosclerotic plaque?

A

Endothelial dysfunction

24
Q

Which cells become foam cells?

A

Macrophages

25
Q

What are the 2 methods of atheromatous thrombosis?

A

Erosion / rupture of plaque

26
Q

What is the mechanism of erosion of an atheromatous plaque?

A

Inflammatory cells producing proteases which cut endothelial cells away from the vessel wall

27
Q

What makes an atheromatous plaque unstable?

A

Thin cap - disordered collagen, large lipid core, high density of macrophages producing expressing TF and MMPs, large no of vaso vasorum

28
Q

What are vaso vasorum?

A

Blood vessels within walls of large blood vessels

29
Q

Where do long chain FAs enter the circulation?

A

left subclavian vein - from thoracic duct

30
Q

Which hormone stimulates uptake of FA from the blood into fat and muscle tissue?

A

Insulin

31
Q

What is the treatment for hyperlipidaemia?

A

Lifestyle advice ; statins ; fibrates

32
Q

What is the MOA of fibrates?

A

Decrease serum TG by via PPAR-a
Decrease production and increase uptake
increase cholesterol excretion

33
Q

What should be monitored in pts on fibrates for treatment of hyperlipidaemia?

A

Kidney function - fibrates can increase creatinine levels

34
Q

What is tendinous xanthomata a diagnostic sign of?

A

Familial hypercholesterolaemia

JG Year 2 (28 decks)

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