MI

Question 1

What are the differences between STEMI and NSTEMI?

Answer 1

STEMI:

• ruptured coronary plaque with occlusive thrombus
• ECG is diagnostic

NSTEMI:

• ruptured coronary plaque with subocclusive thrombus
• ECG is non-diagnostic

Question 2

What are the different classifications of AMI?

Answer 2

Type 1: spontaneous AMI
Type 2: ischaemia imbalance 
Type 3: cardiac death 
Type 4a: related to PCI
Type 4b: caused by stent thrombosis 
Type 5: related to CABG

Question 3

What are the clinical manifestations of AMI?

Answer 3

1. Ischaemic myocardial injury:
   - chest pain
   - 4th heart sounds
   - low grade fever
   - leukocytosis and raised inflammatory markers
   - troponin leak
2. Autonomic disturbance
   - tachycardia
   - sweating
   - vomiting

Question 4

What is used in reperfusion therapy for STEMI?

Answer 4

• Aspirin + ticagrelor
• Heparin
• PPCI

Question 5

What is used in emergency treatment for NSTEMI?

Answer 5

1. Aspirin and ticagrelor
2. ± GP IIb/IIIa inhibitor
3. Fondaparinux (factor Xa inhibitor)
4. Anti-ischaemic drugs (BB, nitrates)
5. Angiography ± PCI within 24-96 hrs

Question 6

Give examples of life-saving strategies in AMI.

Answer 6

1. Prevent pre-hospital death from 1° VF
   - get the patient to a defibrillator ASAP
2. Prevent hospital death from heart failure
   - initiate reperfusion therapy ASAP
3. Prevent late deaths from
   a. Recurrent ischaemic events
   - 2° prevention therapy
   b. Lethal arrhythmias
   - implantable defibrillator