11 - MI

Question 1

classic presentation of MI

Answer 1

crushing retrosternal chest pain with pain shooting down L arm and jaw and diaphoresis

Question 2

what is more common in elderly Sx

Answer 2

• no pain or diaphoresis

- syncope, stroke, acute confusion

Question 3

parts of Phx for MI

Answer 3

• appearance
• vitals
• JVP
• auscultation
• cardiac exam
• peripheral pulses

Question 4

3 early and subtle ECG changes in actue MI

Answer 4

1. increase in R wave voltage in precordials
2. hyperacute T wases in precordials
   - symmetric and prominents
3. ST elevation

Question 5

what is worse prognosis on ECG

Answer 5

higher ST elevation and more leads involved

Question 6

investigations

Answer 6

1. CXR only a priority for ruling out dissection
2. trops, but don’t rise for 2-6 hours
   - serial trops

Question 7

6 complications of acute MI

Answer 7

1. arrhythmias
2. conduction disturbances
3. LV pump failure
4. mech. defects
5. thromboembolism
6. pericarditis

Question 8

**4 Tx priorities in STEMIs

Answer 8

1. ASA
2. thrombolysis or PCI
3. LMWH
4. clopidagrel

Question 9

steps to mgmt of MI

Answer 9

1. stabilize
   - O2
2. pharma
   - ASA
   - nitro, except in inferior MI
3. reperfusion therapy - thrombolysis or PCI
4. heparin
5. BB
6. clopidogreal

Question 10

contraindications to TPA

Answer 10

• recent major surgery or active bleed
• Hx of hem. strokes
• severe uncontrolled HTN
• intracranial neoplams
• suspect aortic dissection

Question 11

preferred thrombolytic therapy

Answer 11

PCI

Question 12

2 recommendations for PCI

Answer 12

1. should get in 90minutes

2. if can’t get within 90 minutes then give fibrinolytic therapy

Question 13

4 adv. of LMWH over heparin

Answer 13

1. more predictable anti-coag
2. no need to monitor PTT
3. lower rates of thrombocytopenia
4. better bioavailablilty