Hint
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Answer
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If a patient presents with a suspected MI, which test should be performed first?
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Electrocardiogram (ECG)
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Which cardiac biomarker is gold standard for aiding an MI diagnosis?
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Troponin
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What other bloods should be taken for a suspected MI patient?
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FBC
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U&E
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Lipid profile
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LFTs
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Fasting glucose
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A patient with an MI may be classified as having a STEMI. What other two classifications could an MI patient be diagnosed with?
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NSTEMI
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Unstable angina
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What treatments are used for the IMMEDIATE management of a suspected MI?
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Aspirin
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GTN spray
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Morphine (+ anti-emetic)
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Oxygen
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What is the loading dose for the first drug given as part of immediate management for a suspected MI?
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300mg
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An MI patient will usually only be given an oxygen mask if their O2 sats fall below what %?
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94%
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Once a patient has been diagnosed with a STEMI, they are immediately given what TYPE of drugs to prevent further clotting?
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Anti-platelet
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One of the above drugs given is aspirin. What is the other drug most commonly given in combination with aspirin as part of dual therapy/immediate STEMI management?
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Ticagrelor
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Once a patient has been diagnosed with a STEMI, they are ideally transferred to a cath lab for PCI. What does PCI stand for?
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Percutaneous coronary intervention
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What is the other term for the PCI procedure?
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Coronary angioplasty and stent
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From the time of DIAGNOSIS of a STEMI, how long do doctors have to perform a PCI as the FIRST treatment procedure?
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1 hour ideally, but 2 hours maximum
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From the time of ONSET OF CHEST PAIN, how long do doctors have to perform a PCI as the FIRST treatment procedure?
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12 hours
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If a PCI cannot be performed within the ideal timeframe, what treatment is used for STEMI patients?
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Fibrinolysis
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If a patient is being transferred to a cath lab for primary PCI, should they be given glycoprotein IIb/IIIa inhibitors?
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No
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Fibrinolysis cannot be repeated once given. After fibrinolysis has been given to a STEMI patient, an ECG is performed to evaluate if a follow-up PCI is necessary. What other test may be indicated by the post-fibrinolysis ECG?
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Angiography
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The test mentioned above involves taking x-rays to visualise blood flow in the vessels around the heart. What type of dye is injected into the patient as part of this procedure?
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Contrast dye
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Ticagrelor is an anti-platelet medication used as part of STEMI management. However, it can be contraindicated. What are the two main things that contraindicate this medication (in the context of MI management)?
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High bleeding risk
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Patient is 75+ years old
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When ticagrelor is contraindicated, what drug is offered as an alternative?
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Clopidogrel
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Troponin is one of the cardiac biomarkers used to assess myocardial necrosis. What two other biomarkers are commonly used?
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Creatine kinase (CK-MB)
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Myoglobin
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Bob says that troponins are the best cardiac biomarkers because they rise to the highest levels. Caroline disagrees, and says the reason is because troponin levels rise first, before the other cardiac biomarkers. Vladimir says he regrets ever studying medicine. Who is correct, Bob or Caroline? (Vladimir is obviously right.)
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Bob
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Troponin levels peak approximately how many days post-MI? (PLEASE NOTE: you MUST type the word "day(s)" as part of your answer)
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One day
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Gerald says that troponin levels ALONE are used to diagnose both STEMIs and NSTEMIs. Jude says they're used to diagnose STEMIs only. Ruth says they're used to diagnose NSTEMIs only. Francesca decides to set the uni on fire. Who is correct?
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Ruth. Troponin levels alone can be used to diagnose NSTEMIs, but NOT STEMIs. STEMI diagnosis requires both an ECG and clinical presentation.
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"A troponin test will be performed when a patient presents to A&E with a suspected MI, and will also be performed again three hours later." True or false?
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True
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