Ami 1 Flashcards
(28 cards)
How much is chest pain % in AMI?
10%
Equivalent pain include dyspnea, epigastric pain and pain in left arm and jaw
Differential diagnosis of chest pain?
Pulmonary emoblism, aortic dissection, pneumothorax
What are the arteries that AMI mostly occur in?
Right coronary a.
Left coronary a.—>circumflex a, anterior interventricular a.
Why is Virchow’s triad associated with AMI?
Bcz it includes endothelial damage (caused by plaque rupture/erosion) +blood stasis and hypercoagulability
When does troponin lvls increase?
In NSTEMI
What is the difference between stable and unstable plaque?
Stable plaque has thicker fibrous cap, unlike unstable plaque which has thinner fibrous cap and if it ruptures it will lead to acute coronary syndrome
What is the difference between stable and unstable angina ?
In stable angina , the pain is constant during exercise, pain lasts <10min, pain occurs only while exercising, ST depression, relieved with nitrates
, while in unstable angina the pain gradually increases within 2wks while exercising, pain lasts >10 min, pain occurs while at rest or minimal exertion, ST depression, NOT relieved with nitrates,
How do you confirm the difference between NSTEMI and STEMI?
On several EKG, the presence of ST elevation persistently for more than >20min
What is the difference between unstable angina and NSTEMI?
High troponin lvls in NSTEMI, while normal lvls in USAP
What is the difference between MI type 1 and 2?
Type 1 : MI caused by atherosclerotic plaque rupture
Type 2: mismatch between oxygen supply/demand
What are the 4 pathophysiological processes of ACS?
1-disruption of unstable atheromatous plaque(type1MI)
2-coronary arterial vasoconstriction
3-intraluminal narrowing caused by atherosclerosis or restenosis after stenting
4-mismatch in O2 demand/supply (type2 MI)
Pathophysiology of stable angina and ACS are classified into 2:
1-Dec O2 supply: -flow limiting stenosis, anemia, plaque obstruction ,
2-Inc O2 demand
When do we see partial vs complete arterial obstruction ?
Partial: NSTEMI and unstable angina
Complete: STEMI
**what is the most common component in the thrombus of USAP/NSTEMI vs STEMI
USAP/NSTEMI: platelets are most common
STEMI: FIBRINS—>total occlusion
Describe chest pain that suggest low vs high probability of ischemia?
High: central; crushing, pressure, squeezing, gripping, tightness, heaviness, retrosternal*
Low: peripheral; fleeting, shifting, pleuritic, positional
Location of pain in ACS?
Central chest, back, neck, jaw, epigastric pain and left shoulder
‘’ risk factors for cardiac related chest pain?
Diabetes Miletus
Old age
Male
Renal insufficiency
Hypertension
Hyperlipidemia
Family history
Peripheral and carotid artery disease
Known CAD
Most imp finding in physical exam for ACS?
Diaphoresis
What are the ECG findings in NSTEMI?
-transient ST elevation <20min
-persistent/transient ST depression
-T wave inversion/flattening
-can be normal
‘’’ in which leads is the occlusion of left circumflex artery detected?
V7-V9
‘’’ in which leads is the occlusion of right ventricular MI detected?
V3R and V4R
Even if the EKG is normal in a pt with chest pain, what should be done?
EKG should be repeated every 20-30min
Which layer of the heart is more prone to ischemia?
Subendocardial layer
Which layer is affected in NSTEMI vs STEMI?
NSTEMI(ST depression+T inversion): subendocardial layer
STEMI: Transmural
