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14 Cards in this Set
- Front
- Back
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What is ACS? |
Acute conronary syndrome = NonSTEMI, STEMI and angina |
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What is the diagnostic critera needed for MI? |
Rise and or fall in troponin level with at least one value > 99th percentile of the URL. Specific as myocardial cells are the only source of troponin. Integrity of cell membranes is lost in MI. Troponin in 2 samples 12hrs apart. PLUS 1 of 3: ECH changes, symptoms of ischaemia, new loss of viable myocardium/new regional wall motion abnormality.
plus: 4th heart sounds chest pain low grade fever leucocytosis troponin leak tachycardia sweating vomitting ECG changes imaging showing loss of viable tissue. |
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What is the mortality in acute MI? |
60% |
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What are the 2 forms of MI? |
NonSTEMI = partially occluding= subocclusive thrombus STEMI = fully occluding thrombosis |
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Name 3 other major complications of MI: |
3o AV block Papillary muscle rupture VSD |
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What are the 3 life-saving strategies for MI? |
1. Prevent hospital death from 1o VF => defibrillate asap.
2. Prevent hospital death from heart failure
3. prevent late deaths from recurrent ischaemic events and lethal arrhythmias = 2o prevention therapy and implantable defibrillators.
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What are the key steps of reperfusion/emergency treatment therapy? |
DIfferent between STEMI and NSTEMI
STEMI = have tPA wherease NSTEMI = give anti-ischemic drugs = BB and nitrates.
Both: 1. Aspirin and clopidogrel 2. Fondaparinux
STEMI: = tPA
NSTEMI: Antiischaemic drugs: BB and nitrates
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What secondary prevention drugs are given? |
BB ACEI Aspirin Statin Clopidogrel |
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What secondary lifestyle prevention measures can be taken? |
exercise, smoking and diet. |
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What are the primary treatment and secondary prevention drugs? |
1. aspirin, fondaparinux,GTN, tPA and sometimes PCI
2. clopidogrel, ACEI, BB, Statin and aspirin |
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What are the criteria for diagnosis of high risk patients? |
tests that are readily available in the bulk of patients. tests that can be performed sufficiently early high sensitivity high positive predictive accuracy. therapeutic implications of abnormal results well defined. |
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How is NSTEMI assessed for risk? |
Grace score: based on age HR SBP Creatine CHF
High risk = > 140 Intermediate = 109-140 Low = <108 |
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What are the implications for implantable defibrillators for AMI? |
2o prevention: late cardiac arrest VT/VF sustained VT with syncope sustained VT and LVEF <35%
1o prevenetion: AMI > 4 weeks previously LVEF <30% and QRS > 120 ms. LVEF <35% and non-sustained VT on holter. |
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What is the prognosis for STEMI and NSTEMI? |
STEMI - has the worse immediate prognosis wherease NSTEMI shouldn't be underestimated as it has the worst long term prognosis. |
