Myocardial Infarction

Question 1

What are the signs and symptoms of an MI?

Answer 1

Chest/back/jaw pain
Indigestion
Sweatienss / claminess
Dyspnoea
Tachycardia
Distressed patients
Heart failure
Shock
Arrythmia

Question 2

The release of which protein into the bloodstream is a marker of. cardiac necrosis?

Answer 2

Troponin

Question 3

Elevated troponin is always an indicator of an MI. T/F?

Answer 3

False - this could be an MI but there are also other causes

Question 4

Describe type I MI?

Answer 4

Spontaneous MI due to a primary coronary event e.g. coronary plaque rupture and formation of thrombus

Question 5

Describe type II MI?

Answer 5

Increased oxygen demand or decreased oxygen supply e.g. heart failure, sepsis, anaemia, arrhythmia, hypertension, hypotension

Question 6

Describe type III MI?

Answer 6

Sudden cardiac death

Question 7

Describe type 4A MI?

Answer 7

MI associated with percutaneous coronary intervention

Question 8

Describe type 4B MI?

Answer 8

Mi stent thrombosis documented by angiography or PM

Question 9

Describe type 5 MI?

Answer 9

MI associated with CABG

Question 10

What is unstable angina?

Answer 10

An acute coronary event without a rise in troponin

Question 11

An acute coronary syndrome with ST elevation is indicative of…?

Answer 11

MI

Question 12

An acute coronary syndrome with no ST elevation but troponin elevation is indicative of…?

Answer 12

MI

Question 13

An acute coronary syndrome with no ST elevation and no troponin elevation is indicative of…?

Answer 13

Unstable angina

Question 14

Why is ST elevation not seen with a posterior infarct of the heart?

Answer 14

No ECG leads look directly at the posterior aspect of the heart

Question 15

Anteroseptal infarcts indicate occlusion of which artery?

Answer 15

Left anterior descending artery

Question 16

Posterior infarcts indicate occlusion of which artery?

Answer 16

Circumflex artery (sometimes right coronary artery)

Question 17

Lateral infarcts indicate occlusion of which artery?

Answer 17

Left circumflex artery

Question 18

What. finding on an ECG indicates a previous MI?

Answer 18

Negative Q wave

Question 19

Which are the anterior leads of an ECG?

Answer 19

V1,2,3 and 4

Question 20

An anterior STEMI is shown in the anterior leads. There is also reciprocal ST depression in which leads?

Answer 20

Inferior leads (II, III, aVF)

Question 21

A high lateral STEMI shows elevation in which leads?

Answer 21

The high lateral leads (I and aVL)

Question 22

A high lateral STEMI shows elevation in leads I and aVL. This also shows reciprocal ST depression in which leads?

Answer 22

Inferior leads (II, III, aVF)

Question 23

An inferior STEMI shows ST elevation in the inferior leads (II, II and aVF) and reciprocal ST depression in which leads?

Answer 23

High lateral leads (I and aVL)

Question 24

How can posterior ST elevation be shown indirectly on an ECG?

Answer 24

Reciprocal ST depression in the anterior leads (V 1,2,3 and 4)
Sometimes subtle ST elevation in inferior leads (II,III and aVF)

Question 25

What are the indications of a left bundle branch on an ECG>

Answer 25

QRS >120ms and a dominant S wave in V1

Question 26

What protocol is used for the immediate management of MI?

Answer 26

ABCD protocol

Question 27

What drugs are given in the immediate management of MI?

Answer 27

``` 300mg Aspirin PO Unfractionated her pain 5000U IV Morphine 5-10mg IV Anti-emetics Clopidogrel if in ambulance and ticagrelor is in hospital ```

Question 28

What are the advantages of primary percutanoues coronary intervention when compared to thrombolysis?

Answer 28

``` Improves survival Reduces trokes Reduces the chance of further MI Reduces the chance of further angina Speeds up recovery and shortens the time spent in hospital ```

Question 29

What technique can be used to place a small coronary stent in the immediate management of MI?

Answer 29

Transradial percutaneous intervention

Question 30

What drugs should be given to all MI patients for the secondary prevention?

Answer 30

ACE inhibitors Beta blockers Statins Aspirin

Question 31

Which patients should receive eplerenone for secondary prevention of MI?

Answer 31

Diabetes Left ventricular systolic dysfunction Clinical heart failure

Question 32

What are the potential complications of MI?

Answer 32

``` Arrythmias Heart failure Cardiogenic shock Myocardial rupture Psychological ( anxiety/depression) ```

Question 33

Myocardial rupture of the papillary muscle due to MI will cause...?

Answer 33

Mitral regurgitation

Question 34

How does myocardial rupture of the free wall due to MI lead to death?

Answer 34

By causing cardiac tamponade

Question 35

Myocardial rupture of the septum due to MI will cause...?

Answer 35

Ventricular septal defect

Question 36

How is cariogenic shock as a result of MI treated?

Answer 36

Intra-aortic balloon pump | Ventricular assist device

Question 37

How is heart failure as a complication of MI treated?

Answer 37

Diuretics Inotropes Vasodilators

Question 38

If there is left ventricular dysfunction at >9months after MI then what treatment should be considered?

Answer 38

Implantable cardioverter defibrillator

Question 39

What risk score system is used to determine which patients get further inpatient care for NSTEMIs?

Answer 39

GRACE risk score

Question 40

What are the requirements in order for a finding of ST elevation to be significant>

Answer 40

>1mm in limb leads and >2mm in chest leads | Present in at least two leads

Question 41

In what situations would oxygen be given for MI?

Answer 41

When the patient is hypoxic (just as with any other condition)

Question 42

When would thrombolysis be used instead of PCI to reperfuse a STEMI patient?

Answer 42

When for geographical reasons a patient can't reach a PCI centre in time