What are the contraindications for thrombolysis?
• Recent surgery, trauma or head injury • Suspected aortic dissection or stroke • Allergy to streptokinase • Severe hypertension in which you would
Which cardiac troponin are sensitive for acute MI?
Troponin I and T
True or False: You would treat an NSTEMI similarly to STEMI ie. MONA+C
What is the pharmacological management for acute heart failure?
LMNOP: - Loop diuretics (e.g. furosemide) – to clear the fluid from her lungs - Morphine - Nitroglycerin - Oxygen - Position – get them to sit up
Chronic stable angina
There is a fixed stenosis which is entirely predictable and safe, and is caused by demand led ischaemiathere is a fixed stenosis which is entirely predictable and safe, and is caused by demand led ischaemia
Acute coronary syndrome
Any acute presentation of coronary artery disease. Includes unstable angina, NSTEMI and STEMI
True or False: Stable angina is supply led ischaemia
False, it is demand led ischaemia (on exertion)
True or False: ACS is supply led ischaemia
True, it is unpredictable and can be on rest
What is the difference in the pathophysiology of an NSTEMI and a STEMI?
NSTEMI occurs by developing a complete occlusion of a minor coronary artery or a partial occlusion of a major coronary artery previously affected by atherosclerosis. This causes a partial thickness damage of heart muscle. STEMI occurs by developing a complete occlusion of a major coronary artery previously affected by atherosclerosis. This causes a full thickness damage of heart muscle.
**What are the clinical findings of NSTEMI on ECG?
ST-segment depression or T-wave inversion
**What are the clinical findings of STEMI on ECG?
ST segment elevation in ECG in first few hours, and pathological Q-wave and T-wave inverse in first few days
Clenched fist over chest
**In terms of history, how do you differentiate angina from MI?
Which leads indicate an inferior MI?
II, III, AVF
Which leads indicate an anterior MI?
Which leads indicate an anteroseptal MI?
Which leads indicate an anterolateral MI?
I, avL, V1-V6
What are the complications of MI?
D - death A - Arrhythmia R - Rupture (free ventricular wall/ ventricular septum/ papillary muscles) T - Tamponade H- Heart failure (acute or chronic) V- Valve disease A - Aneurysm of ventricle D - Dressler's syndrome E - Embolism (mural thrombus) R - Recurrence
Cessation of the heart (meaning no circulation and therefore no oxygen delivery)
What is the target time of defibrillation with cardiac arrest?
Within 3 mins
What is the chain of survival?
1) Early recognition and call for help to prevent cardiac arrest 2) Early CPR to buy time 3) Early defibrillation to restart the heart 4) Post rests care to restore quality of life
What are the main causes of cardiac arrest generally associated with?
Airway, breathing and circulation - i.e., oxygen delivery problems. Including low SaO2, low Hb, HR, low BP
Which intervention can you do to increase preload for treatment of cardiac arrest?
IV fluids and raise legs
**What are the differences between asleep, unconscious, respiratory arrest and cardiac arrest?
**What is the management for the different categories of patients in terms of basic life support?
To what depth should chest compressions be?
At what rate should chest compressions be given?
100-120 per minute
At what ratio should compressions: rescue breathes be given?
Which cardiac rhythms are shockable?
Ventricular fibrillation and ventricular tachycardia
Which cardiac rhythms are non-shockable?
Asystole/ Pulseless electrical activity
Use of electrical current to “reset” heart electrical rhythm with hope that regular rhythm will recur.
What is the management of asystole?
Adrenaline 1 mg IV as soon as possible (every 3 – 5 min thereafter (every 2 cycles))
**What are the main reversible factors contributing to cardiac arrest, and how would you treat each of these?
4 H's and 4 T's:
- Thrombosis - coronary or pulmonary
- Tension pneumothorax
- Tamponade - cardiac
What does Post-Cardiac Arrest Syndrome involve?
1. Post-cardiac arrest brain injury 2. Post-cardiac arrest myocardial dysfunction 3. Systemic ischaemia / reperfusion response 4. Persistent precipitating pathology
Which 2 enzyme markers can be used to identify MI?
Troponin (released from myocytes when irreversible myocardial damage occurs) and creatinine kinase