ACS - Myocardial Infarction

Question 1

what is the most cause of sudden cardiac death

Answer 1

ventricular fibrillation, flutter/tachycardai indiced by an ischaemic substrate

Question 2

another cause of SCD carrying a poor prognosis

Answer 2

heart block and bradycardic syndromes with LAD territory infarcts

Question 3

why is reperfusion arrhythmias another cause of SCD

Answer 3

The heart is already in a compromised, “barely holding on” state. When hit with a sudden metabolic storm of oxygen, ions, and ROS, it becomes electrically chaotic → leading to fatal arrhythmias.

Question 4

what main feature is a suspetcted diagnosis of MI

Answer 4

chest pain

Question 5

CAD disease is a risk factor of

Answer 5

arrhythmias, HF, ACS, chronic stable angina

Question 6

diagnosing coronary disease

Answer 6

• chest pain
• nausea
• fatigue
• sweating
• syncope
• SOB
• palpitations
• prioir cardiac disease

Question 7

characterise the chest pain in coronary disease

Answer 7

constricting feeling in neck, black out and palpitation

• but there can also be a silent MI = no chest pain

Question 8

know the location of chest pain during angina

Question 9

differentials for MI

Answer 9

• cardiac
• chest wall
• lung
• GIT
• neurologic

Question 10

cardiac - 7

Answer 10

• ischameia
• pericarditis
• myocarditis
• prolapse
• aortic dissection
• aortic stenosis
• heart failure

Question 11

chest wall - 2

Answer 11

costochondritis, zoster

Question 12

pulmonary -4

Answer 12

• pneumonia
• pulmonary embolism
• pneumothorax
• pleurosity

Question 13

neurologic - 2

Answer 13

• anxiety
• discopathy

Question 14

GIT - 5

Answer 14

• GORD
• boehave
• pud
• cholecytititis
• pancreatitis

Question 15

what dont we give in a patient with aortic dissection

Answer 15

dont give a thrombolytic or antiplatelet bc they lead to increase bleading, this worsening the dissection, leading to rupture

Question 16

NSAIDs CI

Answer 16

• statins.. dont give gout packs (contain nsaids) with statins bc they increase rhambdomylosis
• dont give with aspirin and clopidogrel as well

Question 17

3 diagnostic criteria for MI

Answer 17

• chest pain
• ECG
• biomarkers (troponin mainly)

Question 18

stable angina on ECG

Answer 18

normal

Question 19

UA on ECG

Answer 19

• normal or abnormal without elevation, with normal biomarkers (REMEMBER THIS BC ITS AN ANGINA AND NOT AN INJURY)

Question 20

NSTEACS

Answer 20

normal or abnormal ecg with no elevation and raised biomarkers

Question 21

STEMI

Answer 21

• elevation
• new BBB
• raised biomarkers

Question 22

what is the nature of an UA

Answer 22

new onset within the last month, of crescendo nature

Question 23

UA and NSTEAC

Answer 23

same thing sana, just that the latter has increased cardiac biomarkers

Question 24

define MI

Answer 24

rise or fall of atleast one biomarkers above the 99TH PERCENTILE of the upper reference limit

Question 25

symptoms of ischamia

Answer 25

- they could also mean infarction - pathological Q waves - new ST and LBBB - loss of viable myocardium or new regional wall motion abnormality

Question 26

whats PCI in full

Answer 26

- Percutaneous Coronary Intervention. - it involves placing a stent to open up the occluded artery

Question 27

reperfusion

Answer 27

- stent and thrombolysis - they are only good when done early, within 12 hours of symptom onset

Question 28

the older the clot

Answer 28

the less likely the lytic will work - administer it in less than 30 mins- a thrombolysin or fibrolysin

Question 29

when to administer PCI

Answer 29

Primary PCI is the best option for patients — as long as they can be moved to a hospital that can do it within 2 hours of first getting medical help.

Question 30

is aspirin better than streptokinase

Answer 30

no, no one is better than the other, infact they are better together

Question 31

nitrates

Answer 31

for pain relief, but they dont reduce infarct size

Question 32

opioids

Answer 32

pain relief

Question 33

for an MI, how many antiplatelets should be given

Answer 33

- atleast 2, but the other one should always be ASPIRIN - please check page 33

Question 34

we give lytics in STEMI or NSTEMI

Answer 34

STEMI ma babes

Question 35

can you give PCI immediately after thrombolysis

Answer 35

never sana, that causes mortality

Question 36

learn the classes of PCIs

Question 37

shock trial

Answer 37

patient developing shock within 36 hours have reduced mortality with emergency revascularization vs medical stabilisation

Question 38

what is a extracoporeal membrane oxygenation

Answer 38

a device that acts like your heart and lungs outside of your body

Question 39

advantages of extracoporeal membrane oxygenation

Answer 39

- augments cardiac output, 4.5 l/min - does not require stable cardiac rhythm - support fro several weeks

Question 40

EMO disadvantage -9

Answer 40

- not universally available - no pulsative flow - risk of lung ischaemia - lung overventillation leading to ALKALOSIS -requires use of inotropes - systemic embolisation - stroke, infarction - lower limb ischaemia - hemolysis

Question 41

what is an impella

Answer 41

A tiny heart pump placed inside your heart to help it pump blood when it’s too weak.

Question 42

advantages of an impella

Answer 42

- augments CO 2.5-4.5 - only offers support for 7 days -also does not require a stable cardiac rhythm, but needs adequate LV filling

Question 43

disadvantage of imeplla

Answer 43

- availability - same things as my EMO sana

Question 44

loading dose for PCI

Answer 44

600 mg clopidogrel

Question 44

left ventricular assist device - tandem heart addvantages

Answer 44

- augments CO by 4-5 - does not require stable rhytm - supports fro 14 days

Question 44

loading dose for thrombolysed and undergoing PCI within 24 hours

Answer 44

300 mg clopidogrel

Question 45

tandem heart disadvantages

Answer 45

- 21F cannula - tip cannula displacement into RV with severe desaturation - transeptal puncture

Question 45

whats the longest time one has survived with a LVAD

Answer 45

- 7 hours - thing has 14 hours battery life - learn other qualities

Question 46

thienopyridines

Answer 46

prasugrel

Question 46

GpIIb/IIIa inhibitors

Answer 46

- not recommended for use with thrombolytics

Question 47

thrombectomy device

Answer 47

used to suck out the clot

Question 47

optical coherence tomography

Answer 47

A special imaging technique that uses light to take very detailed pictures of inside the body — like a microscope that works from the inside., gives 3D images