MI

• What is a STEMI?

  Complete occlusion of a CA
• What is a NSTEMI?

  Severe but incomplete stenosis/occulsion

  OR:

  decreased oxygenation due to sepsis/hypotension/hypovolemia/CA spasm
• What is QRISK3?

  Assess risk of stroke/MI in next 10 years
• What does QRISK3 assess?

  Age

  Gender

  Co-morb e.g. DM, AF, CKD, RA, SLE

  Meds e.g. steroids, antipsychotics
• What AI conditions inc risk of Myocardial Infarction?


  RA & SLE
• What ECG marker may detect a prior silent/unregonised MI?

  Pathological Q wave
• What is seen in this ECG?

  St elevation leads V1 - V4

  
• What normally causes an anterior STEMI?

  Occlusion of LAD
• What artery is usually occluded in an Inferior STEMI?

  RCA
• What artery is usually occluded in a Lateral STEMI?

  Left circumflex
• What would levels of Creatinine-Kinase MB be like after an MI?

  High
• How do you calculae Ejection Fraction?

  SV/EDV
• What are 7 ddx for MI?

  Angina

  Myocarditis

  PE

  Oesophageal rupture

  Pericarditis

  Anxiety

  Acute cholecystitis
• What management can be done if a patient presents within 12hrs of symptom onset for an STEMI?

  Percutaneous Coronary Intervention
• What should be done if PCI can't be done for an STEMI?

  Fibrinolysis
• What 2 drugs may be given after PCI/Fibrinolysis for a STEMI?

  Clopidogrel or prasugrel
• What may be given to ease symptoms of a MI?

  Morphine

  High flow O2

  Nitrates

  Anti-emetics
• What Nitrate may be given in MI management & why?

  Sublingual GTN spray - symptom relief
• How does management differ between a STEMI/NSTEMI?

  1st line = aspirin

  For NSTEMI = only do PCI if determined as high risk, if now risk give clopidogrel and prasugrel
• What dose of aspirin is given for an MI?

  300mg
• Why may chewable aspirin be given?

  Absorbed faster = quicker response
• What is the role of low dose aspirin?

  Anti-platelet
• What makes up Percutaneous Coronary Intervention?

  Coronary angioplasty

  Stenting
• What is Percutaneous Coronary Intervention?

  Procedure to widen blocked/narrow CA
• A patient comes into the ED with left-sided chest pain, SOB and sweaty. ECG is shown. What is the likely diagnosis and why?

  Posterolateral MI

  Why:

  • ST elevation in I, aVL and V6
  • ST depression in V1-3

  
• What would tall R waves in leads V1-3 mean when seen on an ECG?

  Posterior MI
• What is a classic ECG finding for posterior MI?

  Tall R waves in V1-3