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Flashcards in Treatment for acute MI Deck (21):
1

General therapy for MI

MONA+C
-oxygen >90% CLASS I
-aspirin 300mg
-clopidogrel 600mg

2

Anti-emetic you could give with morphine

Metoclopramide
Cyclizine

3

When would you not give a beta-blocker?

signs of heart failure,
evidence of a low output state,
increased risk for cardiogenic shock, or
relative contraindications to beta blockade
1AVB > 0.24 sec,
2nd- or 3rd-degree heart block
reactive airway disease

4

When should you give beta blockers for an MI?

Within the first 24 hours

5

PCI time window

Within 90 minutes of MEDICAL CONTACT

6

Fibrinolytic time window

Within 30 min of HOSPITAL PRESENTATION (unless contraindicated)

7

What kind of bolus of Reteplase would you give?

double bolus

8

Contraindications to thrombolysis

Recent surgery, recent trauma or head injury, bleeding diatheses, coma, active peptic ulcer, recent stroke, suspected aortic dissection, traumatic resuscitation attempt, allergy to streptokinase (for streptokinase but alternative can be given) etc. Severe hypertension – control the blood pressure first eg with GTN then proceed.

9

Thromboylsis and severe high blood pressure?

Control high blood pressure first before you commence with thrombolysis (control with GTN)

10

Streptokinase side effects

nausea, hypotension, allergy, bleeding, reperfusion arrhythmias

11

tPA (alteplase) side effects

Bleeding, Reperfusion arrhythmias

12

Opiate side effects

sedation, hypoventilation, nausea

13

High flow oxygen side effects

Type II respiratory failure

14

Beta blocker side effects

bradycardia, cardiac failure, bronchospasm in asthma & chronic bronchitis, hypotension

15

Treatment for ischaemic VT?

DCCV, cath lab (if needed), electrolyte correction, amiodarone, lidocaine, beta-blockers

16

Complications of MI

Arrhythmias
Ventricular Septal Perforation
Ischemic Mitral Regurgitation, Papillary Muscle Rupture
Ventricular Free Wall Rupture
Systemic Embolism
Ventricular Aneurysm
Pericarditis
Cardiogenic Shock

17

Cardiogenic shock/pulmonary oedema and MI treatment?

MONA - Morphine, Oxygen, Aspirin
No nitrates because hypotensive
No beta-blocker b/c in heart failure
IV frusemide
I.V. Inotropic agents:
Dobutamine / Dopamine
Intra-aortic balloon pump

18

Secondary prevention following MI

-Physical activity for 20-30mins a day
-Quit smoking
-Mediterranean style diet
-2-4 portions of oily fish per week (if they can't achieve this: 1g of daily omega-3 acid for secondary prevention up to 4 years)

19

When should aspirin and clopidogrel be prescribed?

-after an NSTEMI
-after PCI and stents

20

Drug therapy for all when ya are going home

All patients who have had an acute MI should be offered treatment with the following drugs:
-ACE (angiotensin-converting enzyme) inhibitor
-aspirin
-beta-blocker
-statin

21

Drug therapy: aldosterone antagonists following MI

Patients with symptoms and signs of heart failure will require an early assessment of LV function.
Those with symptoms or signs of heart failure and LVSD should be offered a licensed aldosterone antagonist within 3–14 days of the acute MI