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24 Cards in this Set
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Module 4 - logbook 8: definition (MI) |
STEMI = ST elevation and raised troponin - total blockage NSTEMI = ST depression/nothing and raised troponin - partial blockage |
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Module 4 - logbook 8: epidemiology (MI) |
114,000 ACS admissions per year STEMI/NSTEMI divide difficult to calculate |
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Module 4 - logbook 8: risk factors - modifiable (MI) |
Smoking, hypertension, alcohol, BMI, cholesterol, diabetes and physical inactivity |
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Module 4 - logbook 8: risk factors - non modifiable (MI) |
Family history (hyperlipidemia), ethnicity (India, Pakistan and Bangladesh), age and gender |
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Module 4 - logbook 8: common presentation (MI) |
Chest pain > 20 mins at rest. May be associated with sweating, nausea, vomiting, dyspnoea, fatigue,shortness of breath and palpitations. Women - arm, back neck and jaw |
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Module 4 - logbook 8: investigations (MI) |
12 lead ECG, cardiac enzymes (troponin I ant T) peak at 12-24 hours |
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Module 4 - logbook 8: pathophysiology (MI) |
Total blockage leading to myocardial cell death |
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Module 4 - logbook 8: anatomy (MI) |
Right coronary artery - inferior - II III AVF Left anterior descending - anterior - V1-V6 AVL Left circumflex - lateral 1, AVL, V5 V6 Posterior V1-V4 depression |
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Module 4 - logbook 8: prognosis (MI) |
5-10% mortality in hospital. 5-10% have an MI within a month. Much worse with left dominance |
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Module 4 - logbook 8: management (and NICE guidelines) (MI) |
Morphone, GTN, oxygen (if O2 < 94%), ASPIRIN 300mg and CLOPIDOGREL 300mg) Immediately assess eligibility for coronary reperfusion therapy. Offer fibrinolysis (prevents blood clots from growing and becoming problematic) to people with acute STEMI presenting within 12 hours of onset of symptoms. |
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Module 4 - logbook 8: drugs - ASPIRIN |
Antiplatelet - Acetyl donor to COX rendering it inactive which reduces thromboxane A2 |
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Module 4 - logbook 8: drugs - TICAGRELOR |
Antiplatelet - prevents binding of ADP preventing activation of clotting factors stopping fibrinogen and platelet aggregation |
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Module 4 - logbook 8: drugs - SIMVASTATIN |
Hypercholesterolemia - enzyme inhibitor HMG coA reductase, reducing quantity of mevalinic acid, a precursor of cholesterol |
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Module 4 - logbook 8: drugs - BISOPROLOL |
MI prophylaxis - beta blocker - blocks beta 1 receptors reducing sympathetic stimulation |
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Module 4 - logbook 8: drugs - LANSOPRAZOLE |
PPI. Reduces gastric acid by inhibition of H+K+ ATPase enzyme system |
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Module 4 - logbook 8: drugs - FONDAPARINUX |
Anticoagulant - ATIII mediated inhibition of factor Xa interrupting clotting cascade. less likely thrombocytopenia vs LMWH |
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Module 4 - logbook 8: anatomy (pericardium) |
Double walled sack containing heart Fibrous pericardium (superficial - connective tissue) Serous pericardium (parietal and visceral) - lubricates the heart Functions: 1. lubrication 2. stops heart over-dilating 3. prevents transfer of infection 4. fixes heart in mediastinum |
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Module 4 - logbook 8: epidemiology (pericarditis) |
1/20 chest pain A&E visits. Men > women. Adults > children |
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Module 4 - logbook 8: pathophysiology (pericarditis) |
Acute inflammation. fibrinous reaction can result in exudate and adhesions within the pericardial sac > effusions and tamponade |
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Module 4 - logbook 8: aetiology (pericarditis) |
Usually post-viral or idiopathic. Viral: Coxsackievirus, influenza, Rheumatological: RA, SLE Bacterial: Staphylococcus, neoplasm, drugs and MI |
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Module 4 - logbook 8: common presentation (pericarditis) |
Symptoms: pain - aggravated by inspiration, swallowing, coughing and lying flat, relieved by sitting up and leaning forward. Signs: pericardial friction rub (extra heart sound - grating. Also tachycardia and fever |
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Module 4 - logbook 8: ECG and other investigations (pericarditis) |
Stage 1: wide spread saddle shaped ST elevation Stage 2: ST segments down T waves flatten Stage 3: T waves invert Stage 4: T waves return to normal (electrical alternans in tamponade) CXR (flask shaped heart in tamponade), blood tests, echocardiogram and CT/MRI if in doubt |
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Module 4 - logbook 8: management (pericarditis) |
Community: underlying cause and NSAIDs. High risk (e.g. high temp, Warfain, traums) > hosptial If tamponade develops then pericardiocentesis |
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Module 4 - logbook 8: prognosis (pericarditis) |
Normally self limiting in days-weeks. Rapid response to NSAIDs >> good prognosis. Re-occurrence common. Mortality rate approaches 85% for untreated TB pericarditis |