MI

Question 1

What is a Myocardial Infarction

Answer 1

AKA heart attack
Occurs when this is myocardial necrosis following atherosclerotic plaque rupture, which occludes one or more of the coronary arteries.
MI is part of the acute coronary syndromes

Question 2

What are acute coronary syndromes

Answer 2

ST elevation MI (STEMI)
Non-ST elevation MI (NSTEMI)
Unstable angina

Question 3

Cause of MI

Answer 3

Atherosclerosis

Question 4

Symptoms

Answer 4

Nausea, sweating, palpitations

Crushing chest pain for more than 20 minutes

Question 5

In what patients can symptoms of a MI be silent

Answer 5

Diabetics

Question 6

Signs

Answer 6

RIP:
Raised JVP (jugular venous pressure)
Increased pulse, blood pressure changes
Pallor, anxiety

Question 7

Types of infarct

Answer 7

Transmural

Subendocardial

Question 8

What is a Transmural infract

Answer 8

Affects all of the myocardial wall

Question 9

Describe ECG of transmural infarct

Answer 9

ST elevation

Q waves

Question 10

What is a subendocardial infarct

Answer 10

Necrosis of <50% of the myocardial wall

Question 11

Describe ECG of subendocardial infarct

Answer 11

ST depression

Question 12

Complications of MI

Answer 12

C PEAR DRoP
Cardiogenic shock; Cardiac arrhythmia

Pericarditis
Emboli
Aneurysm
Rupture of ventricle

Dressler’s syndrome
Rupture of free wall
o
Papillary muscle rupture

Question 13

What is Dresslers syndrome

Answer 13

An autoimmune pericarditis that develops 2-10 weeks post MI
This is a triad of:
Fever
Pleuritic pain
Pericardial effusion

Question 14

Investigations

Answer 14

ECG
CXR
Bloods (look for cardiac biomarkers)
Angiography with the view to perform percutaneous coronary intervention (PCI)

Question 15

What would you see on ECG

(see specific ecgs

Answer 15

May show:
ST elevation, ST depression, inverted T waves
New LBBB
Pathological Q waves

Question 16

What would you see on CXR

Answer 16

Cardiomegaly
Pulmonary oedema
Widening of the mediastinum

Question 17

Cardiac biomarkers seen on blood test

Answer 17

Troponin I

Troponin T

Question 18

Conservative treatment

Answer 18

Lifestyle measures such as smoking cessation and increased exercise

Question 19

Surgical treatment of STEMI

Answer 19

Reperfusion with Percutaneous Coronary Intervention

Question 20

Surgical treatment of NSTEMI

Answer 20

PCI may be used, but if patients are not having immediate PCI: Fondaparinux (Factor Xa inhibitor) or LMWH may be given subcutaneously

Question 21

Medical treatment

Answer 21

Immediate management = MONA B
Morphine
Oxygen (if hypoxic)
Nitrates (GTN)
Anticoagulants (aspirin and an antiemetic)

(PCI would be here)
Beta-blockers if no contra-indication

Question 22

What should all patients be prescribed on discharge

Answer 22

Aspirin
ACE inhibitor
Beta-blocker (if no Contra-indication)
Statin

Can give Calcium channel blocker if contra-indication to beta-blockers