STEMI SIMLive!

Based on the triage notes, what risk factors does Jennifer have for cardiovascular disease (3 examples)?

How should the doctor administer oxygen to Jennifer?

• Jennifer does not need oxygen

• 2L oxygen via a Nasal Cannula

• 4L oxygen via a Face Mask

• 35% oxygen via a Venturi Mask

• 15L oxygen via a non-rebreathe mask

What blood tests should the doctor request?

• D-Dimer, Liver Function Tests, Serum protein electrophoresis, Lipids

• Troponin, Thyroid Function Tests, Coagulation Screen, Glucose, Ferritin

• Coagulation screen, Urea & Electrolytes, Liver Function Tests, Glucose

• Full blood count, Urea & Electrolytes, Lipids, Glucose, Troponin

• Lipids, Troponin, Full Blood Count, ANCA screen, D-Dimer

Where should the chest electrodes for the ECG leads be placed on the patient? Select the answer based on the options provided in your resource booklet.

• A

• B

• C

• D

• E

Jennifer's ECG is shown in your resource booklets. What is the most likely diagnosis?

• Anterior ST Elevation Myocardial Infarction

• Atrial Fibrillation

• Inferior ST Elevation Myocardial Infarction

• Lateral ST Elevation Myocardial Infarction

• Ventricular Fibrillation

Which coronary artery is most likely to be affected in this patient?

• Circumflex Artery

• Left Anterior Descending

• Left Main Coronary Artery

• Obtuse Marginal Artery

• Right Coronary Artery

What common side effect is associated with GTN (Glyceryl Trinitrate) Spray?

• Bradycardia

• Epigastric Pain

• Hypotension

• Peripheral oedema

• Shortness of breath

Aspirin is used in STEMI to prevent ongoing thrombus proliferation at the site of the coronary artery occlusion. Put the following steps in order to illustrate how the coronary artery occlusion developed in this patient.

• Smooth muscle and collagen proliferate to form a fibrous cap

• Adhesion activates platelets; leading to further platelet aggregation and activation

• Macrophages and smooth muscle engulf accumulated lipids

• Atheromatous plaque ruptures to expose platelet adhesion sites

• Formation of the fatty streak in the coronary vascular endothelium

Now that Jennifer's acute assessment and treatment is complete, what is the definitive way to diagnose and treat her STEMI?

• Cardiac Magnetic Resonance Imaging

• Delayed Coronary Angiogram + Angioplasty

• Exercise Tolerance Test (ETT) ECG

• Primary Percutaneous Coronary Intervention

• Transcatheter Aortic Valve Implantation (TAVI)

Jennifer is discharged from hospital on Bisoprolol, Ramipril, Aspirin, Prasugrel (for 12 months), Atorvastatin, Metformin, Lansoprazole and a GTN spray. What is the mechanism of action of statins like Atorvastatin?

• Competitive inhibitor of cholesterol receptors

• HMG-CoA Reductase Inhibitor

• Increases LDL receptor expression in vascular endothelium

• Promotes conversion of HDL to LDL

• Up-regulates hepatic LDL synthesis