Myocardial Infarction Flashcards
STEMI
Complete and persistent blockage of artery
NSTEMI
Partial or intermittent blockage of an artery
Risk factors for MI
1) Male
2) Advancing age
3) Manual employment
4) Location - highest in Scotland, lowest in England (highest in NW, lowest in SE)
5) Obesity, smoking. HTN, physical inactivity, high cholesterol, DM, FH
Dressler’s syndrome
Pericarditis occurs in 4% of post-MI patients
2-4 weeks post MI - self-limiting febrile illness + pericardial or pleural pain
Advice post-MI
1) stop smoking inc. passive smoking
2) cardioprotective diet
3) cardiac rehab programme / home-based rehab (www.theheartmanual.com)
4) exercise - 20-30 minutes/day to point of slight breathlessness
5) weight loss if overweight
6) alcohol within limits (14 units/week spread evenly over at least 3 days)
Cardioprotective diet
1) Low refined sugar
2) Salt < 6g/day
3) Wholegrains
4) 4-5 portions of nuts and seeds/week (portion = 30g)
5) > 2 portions of fish/week
6) >5 portions of fruit and veg/day
7) Olive oil or rapeseed oil for spreads, dressings, cooking, baking rather than animal fats eg. butter
8) Fat intake should be < 30% of total energy intake and saturated fat < 7%
9) no evidence for omega-3 & supplemented food
Exercise advice post-MI
1) > 150 mins/week of moderate intensity aerobic exercise (slightly SOB) - brisk walking/cycling/stairs
2) On 2 days do muscle strengthening activities that work all major muscle groups
1 unit of alcohol
Half pint 3% beer
Small measure (25ml) of spirit
Standard measure (50ml) of sherry / port
Medications initiated by secondary care post-MI
1) ACEi
2) Dual antiplatelet therapy for 12m (aspirin + clopidogren/ticagrelor) and then continue aspirin indefinitely - ticagrelor or prasugel more widely used than clopidogrel
3) BB
4) statin
5) If symptoms/signs of HF and LV dysfunction - add aldosterone antagonist (eplerenone) wihtin 3-14 days of MI, preferably after ACEI initiation
NSTEMI/unstable angina management based on 6 month mortality risk
> 1.5% - clopidogrel for 12 months
3% - angiography within 96h
Driving post-MI
G1: does not need to tell DVLA, but should temporarily stop depending on type of MI and treatments
G2: stop for set period and inform DVLA
Sex post-MI
Can resume after 4 weeks, no increased risk of triggering further MI
> 6 months, can consider PDE5 inhibitor, unless on nitrates/nicorandil
Initial management of MI
Oxygen if SpO2 < 94%, monitor with oximeter
Aspirin 300mg
GTN
ECG
Emergency admission: current chest pain/pain in last 12h
Same day assessment: chest pain 12-72h ago
ECG + troponin before further action if chest pain > 72h ago
Management post PCI
Add prasugrel or ticagrelor to aspirin, stop second antiplatelet after 12m (may be less if high risk of bleeding)
Lifestyle advice post MI
1) Mediterranean diet and switch butter and cheese for plasnt based products
2) Exercise 20-30 mins/day until slightly SOB
3) Sex after 4 weeks
