MI

Question 1

What is Dressler Syndrome?

Answer 1

Autoimmune-mediated pericarditis occurring 2-6 weeks after an MI

Question 2

Describe ECG changes in patient with STEMI

Answer 2

acute - ST elevation

days later - T wave inversion

Question 3

MI treatment pathway in hospital

Answer 3

Draw out diagram in treatment pathway PP

Question 4

How does PCI/angioplasty work?

Answer 4

PCI (primary coronary intervention)

Insertion of a stent into occluded vessel via catheter usually through radial artery

Question 5

Under what cirumstances would someone be more likely to get a bypass over PCI?

Answer 5

Admitte >12hrs after onset of symptoms + in/going to develop cardiogenic shock

Question 6

When do you offer fibrnolysis/thrombolysis to a patient?

Answer 6

If presenting within 12hrs of symtptoms When >2hrs until PCI avaliable

Question 7

Where are the arteries taken from for bypass surgery?

How long will someone be off work for?

Answer 7

Internal mammillary artery and saphenous vein

2-3 months

Question 8

From what procedure can renal failure occur?

Answer 8

PCI and CABG

Question 9

How is an angiograph taken?

Answer 9

Contrast pumped into arteries and then xray taken above and below the thorax

Question 10

If pain continued after how much morphine would we be concerned?

Answer 10

> 10mg

Question 11

What blood test is run to test for MI?

What level must they reach to be considered raised?

Answer 11

Troponin T

Above 99th percentile

Question 12

Describe the blood vessel in myocardium during MI?

Answer 12

Occluded - stenosed

Question 13

Why is smoking a risk factor for MI?

Answer 13

Causes endothelial damage

Question 14

What drugs would you immediately give to a patient with suspected MI?

Answer 14

MONA T
Morphine + metocloprimide
Nitrates
Aspirin (300mg)

Ticagrelor

Question 15

If patient recieves thrombolysis treatment what do you then do?

Answer 15

Reassess 60-90mins after
ST still there -> rescue PCI
ST gone -> arrange PCI

Question 16

What drugs are used for secondary care? Whats the one drug that can be stopped?

Answer 16

DABS

Dual antiplatelet - aspirin + ticagrelor
ACE - lisinopril
Beta blocker - propranolol
Statin - simvastatin

Ticagrelor

Question 17

Under what circumstances can’t you recieve thrombolysis?

Answer 17

Previous stroke/bleeding/brain tumour

Hard/forceful CPR

Question 18

What three conditions make up acute coronary syndrome?

Answer 18

Unstable angina
NSTEMI
STEMI

Question 19

How does a patient presentation of NSTEMI differ from STEMI?

Answer 19

They don’t

Question 20

What score do you use to identify the risk level of a patient with a NSTEMI?

Answer 20

GRACE score

Question 21

Describe ECG changes with NSTEMI?

Answer 21

ST depression

Question 22

How would you treat a patient with NSTEMI?

Answer 22

Same as STEMI

Question 23

What drug will ambulance crew give outwith MONAT?

Answer 23

Heparin

Question 24

Complications of MI?

Answer 24

DARTHVADER

Death
Arryhthmia 
Rupture
Tamponade
Heart failure
Valve disorder
Aneurysm of ventricle
Dressler's syndrome
Embolism 
Recurrence/MR

Question 25

What test should be done to confirm an NSTEMI?

Answer 25

Troponin I and T

Question 26

How high should ST elevation be?

Answer 26

2mm in 2 adjacent leads

Question 27

3 signs of STEMI on ECG

Answer 27

- New onset bundle branch block - 1mm+ on 2 adjacent limb leads - 2mm+ on 2 adjacent chest leads

Question 28

``` For each of the following types of STEMI state the artery most likely to be occluded: Lateral Anterior Posterior Inferior ```

Answer 28

Lateral - circumflex Anterior - LAD Posterior - Right coronary artery Inferior - right coronary artery