acute MI Flashcards

Question

arrhythmic complications

Answer 1

> ventricular fibrillation

Answer 2

``` > cardiac rupture >ventricular septal defect >mitral valve regurgitation -LV aneurysm formation -mural thrombus (sometimes with systemic emboli) -inflammation -acute pericarditis -dressler's syndrome ```

Answer 3

inflammation of the pericardium

Answer 4

>mainly just ventricular function ... >acute ventricular failure of LV/RV/both >chronic cardiac failure >cardiogenic shock

Answer 5

1 - no signs of heart failure 2 - crepitations <50 % of lung fields 3 - crepitations >50% of lung fields 4 - cardiogenic shock

Answer 6

the pathogenic trigger is the spontaneous plaque rupture and so antiplatelets are the solution ie clopidogrel and aspirin (standard therapy) >>associated with poorer outcomes , potentially have a higher risk than STEMI

Answer 7

history - heart pain ECG - it may be normal !! biomarker of troponin - can reflect microscopic zone of myocyte necrosis (actin and myosin)

Answer 8

``` >in the presence of an ischaemic ECG changes or elevation of cardiac troponin patents with ACS should be treated immediately with both aspirin 300mg and ticagrelor 180mg > patients with ACS should be considered for aspirin and clopidogrel where the risks outweigh the benefits of ticagrelor and prasugrel >in the presents of an ishaemic ECG changes or elevation of cardiac markers patients with ACS should be treated immediately with fondaparinux or LMWH > in the absence of bradycardia or hypotension, patients with ACS in killip class 1 should be considered for immediate IV and oral beta blockers ```

Answer 9

open another receptor on platelet starting synthesis of fibrinogen which would them go on to aggregate more platelets > so can get GP IIb - a inhibitors

Answer 10

``` misdiagnosis of an ACS based solely off of troponin levels .. troponin levels are also elevate in a series of other conditions ie CCF hypertensive crisis renal failure PE sepsis stroke/tia pericarditis/myocarditis post arrhythmia ```

Answer 11

detection of a rise/fall of carina biomarker values w at least one value above the 99th percentile upper reference limit and with one of the following : - symptoms of ischaemia - new or presumed new significant ST segment - T wave changes on the left branch block - imaging evidence of new loss of viable myocardium or new regional wall motion abnormality - identification of an intracoronary thrombus by angiography or autopsy

Answer 12

``` is secondary to an ischaemic imbalance .. increased myocardial demand for oxygen ie sustained tachycardia significant hypertension marker LVH hypertrophic cardiomyopathy valvular disease ... reduced myocardial oxygen / blood supply anaemia hypoxia and resp. failure bradycardia hypotension vasospasm coronary embolism ```

Answer 13

``` I = sudden symptoms major ECG changes no obvious other cause higher trop. with rise then fall severe CAD on angiography II = less chest pain minor ECG changes tach/low bp/illness smaller more static troponin mild moderate coronary disease ```

Answer 14

not type II cos they don't have a coronary artery disease ... ie pacing , cardiac contusion , received chemotherapy

Answer 15

it inhibits cyclooxyrgenase, preventing the production of prostaglandins and thromboxane A2 from arachnoid acid, TXA2 promotes the expression of the GP IIb/IIIa binding site on the platelet - allowing fibrinogen to bind

Answer 16

is a potent inhibitor of ADP-induced platelet aggregation irreversibly inhibiting the binding of ADP to its platelet membrane receptor (ADP binding is necessary for activation of the GP IIb/IIIa receptor, which is the binding site for fibrinogen) Clopidogrel thus ultimately inhibits the activation of the GP IIb/IIIa receptor and its binding to fibrinogen.