Questions and Answers
Which of the following is NOT a characteristic symptom of myocardial infarction?
Which of the following conditions is a recognized cause of myocardial infarction?
Which diagnostic investigation is most likely to show ST elevations during an acute myocardial infarction?
What is commonly noted in patients with myocardial infarction who have long-standing diabetes?
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Which finding is associated with a severe coronary artery spasm?
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Which of the following is a characteristic feature of Prinzmetal’s angina?
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What defines a non-ST elevation myocardial infarction (NSTEMI)?
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Which of the following is NOT considered a major risk factor for coronary artery disease?
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What type of angina is characterized by chest discomfort that is predictable and occurs with exertion?
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The 'heaviness' or 'tightness' in the chest, commonly associated with angina, is primarily due to:
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Which type of acute coronary syndrome is most severe and involves irreversible damage to heart muscle?
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In which demographic is the major risk factor of age defined as greater than 45 years for males and greater than 55 years for females?
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Sudden cardiac death in patients with coronary artery disease is primarily associated with which condition?
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What is the first serum biomarker to rise after the onset of chest discomfort in STEMI?
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Which of the following conditions cannot be used to diagnose STEMI?
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During the acute treatment of STEMI, what is the primary goal?
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What is a common antidote used in the emergency management of STEMI?
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Which scenario requires emergent cardiac catheterization?
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What can cause a false elevation in biomarkers for myocardial necrosis?
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Which are essential components of immediate treatment for STEMI?
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What is the time frame for troponin levels to peak after myocardial infarction onset?
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Study Notes
Signs and Symptoms of Myocardial Infarction (MI)
- Profuse sweating, nausea, vomiting, and weakness suggest MI, with a sense of impending doom.
- Silent MI may occur with absent pain in patients with diabetes, chronic steroid use, neuropathies, or the elderly.
- Severe dyspnea often accompanies symptoms like sweating and palpitations.
- Characteristic pain is severe, persistent, and usually substernal.
- Sympathetic effects include diaphoresis and cool, clammy skin.
- Parasympathetic (vagal) effects include nausea, vomiting, and weakness.
- Inflammatory response may manifest as mild fever.
- Cardiac findings can include an S4 gallop, dyskinetic bulge in anterior wall MI, and systolic murmurs (e.g., mitral regurgitation).
- Other possible findings include pulmonary rales and jugular venous distention, indicating heart failure.
Causes of Myocardial Infarction
- Atherosclerotic plaque rupture often leads to thrombus formation.
- Vasculitic syndromes and coronary embolism (e.g., from endocarditis) are contributing factors.
- Congenital anomalies and trauma to coronary arteries can cause MI.
- Spontaneous coronary artery dissection and severe coronary artery spasm (including cocaine-induced) are also causes.
- Elevated blood viscosity (e.g., polycythemia) and substantially increased myocardial oxygen demand (e.g., severe aortic stenosis) can trigger MI.
Investigations for Myocardial Infarction
- Resting ECG may reveal ST depressions, ST elevations, or T wave inversions.
- Cardiac markers are crucial for diagnosing conditions like coronary artery disease (CAD).
Coronary Artery Disease (CAD)
- CAD, also known as atherosclerotic heart disease, is caused by plaque buildup in coronary arteries leading to ischemia.
- It results from an imbalance between myocardial oxygen supply and demand.
Risk Factors for Coronary Artery Disease
- Major risk factors include hypertension, diabetes, dyslipidemia, cigarette smoking, family history, age (over 45 for males, over 55 for females), and prior CAD history.
- Minor risk factors encompass obesity, sedentary lifestyle, chronic stress, excessive alcohol use, and passive tobacco smoke exposure.
Presentations of Coronary Artery Disease
- Conditions associated with CAD include stable angina, unstable angina, Prinzmetal’s angina, non-ST elevation MI, ST elevation MI, cardiac syndrome X, and sudden cardiac death.
Acute Coronary Syndrome (ACS)
- ACS represents life-threatening conditions ranging from unstable angina to large acute MIs with irreversible myocardial necrosis.
Angina
- Described as chest "pressure," "tightness," or "heaviness" rather than pain.
- Angina pectoris is the most common symptom of myocardial ischemia.
- Hallmark of STEMI includes clinical history, ST elevations on ECG, and serum markers indicating myocardial necrosis.
ST Elevation Myocardial Infarction (STEMI)
- Cardiac troponin levels rise 3-4 hours post chest discomfort, peak within 18-36 hours, and can remain detectable for up to 10 days.
- High sensitivity and specificity make cardiac troponins the preferred biomarkers for MI detection.
- Conditions complicating STEMI diagnosis include left ventricular hypertrophy, chronic or rate-dependent left bundle branch block (LBBB), and paced rhythms.
Situations Requiring Emergent Cardiac Catheterization
- STEMI or new LBBB indicates a need for immediate intervention.
- ACS with hemodynamic or electrical instability despite optimal medical management also necessitates catheterization.
- Uncontrolled chest pain not relieved by optimal medical treatment warrants urgent action.
Treatment for Acute Coronary Syndromes
- Early coronary angiography and revascularization are crucial for unstable angina or NSTEMI patients with high-risk features.
- STEMI treatment focuses on rapid coronary reperfusion, ideally via percutaneous catheter intervention or fibrinolytic therapy.
- Common treatments include:
- Morphine (5-10mg IV slow injection)
- Oxygen therapy (titrate to needs)
- Nitrates (GTN spray/tablet)
- Aspirin (300mg chewed)
- Antiemetic (Metoclopramide 10mg IV)
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Description
This quiz focuses on the various signs and symptoms associated with myocardial infarction, particularly in specific populations like those with long-standing diabetes and the elderly. It will assess your understanding of the differences in symptom presentation, including silent myocardial infarction. Test your knowledge about the characteristic pain and autonomic effects related to this condition.
