myocardial infarction
| Headline | |
|---|---|
| Etiology | |
| Epidemiology | |
| Clinical presentation | |
| Pathogenesis | |
| Diagnostic investigations | ECG - we all know about ST elevation but what about STEMI equivalents? |
| Immediate management | 300mg loading aspirin ASAP, then: go to PPCI if: - presenting within 12h of s/s and PCI can be done in 120 mins, or - >12h and ongoing myocardial ischaemia/cardiogenic shock then: - prasugrel/clopidogrel/ticagrelor + aspirin if not already anticoagulated - clopidogrel + aspirin if already anticoagulated if presenting within 12h of s/s and PCI cannot be done in 120 mins, fibrinolysis is indicated then: - ticagrelor + aspirin or aspirin +/- clopidogrel if high bleeding risk - no further fibrinolysis, any further intervention = PCI |
cognitive priming - ECGs
Evolving anterior MI
Inferior MI
secondary prevention
- ACE inhibitor - indefinitely
- DAPT - up to 12 months
- beta blocker - indefinitely if ↓ LV function; else, at least 12m
- statin
- MRA - if ↓LVEF, start 3-14d after MI
weird and wonderful
fun fact, MI can occur with Anaphylaxis = "Kounis syndrome" - caused by coronary spasm, displacement of atheromatous plaques because of coronary spasm or stent thrombus
https://www.rcemlearning.co.uk/modules/stinging-the-heart/