16)Ischemic heart disease - management of the acute myocardial infarction complicated with rhythm and conduction disorders, with hypo- and hypertension, with heart failure.

Question 1

if the ischemia affects the right coronary artery what is this importantly feed ?

Answer 1

cells of the san node
ischemia and necrotic cells cannot control their ion currents across their membranes become electrically unpredictable

ischemia can also affect the conductive system

Question 2

what is the management of acute myocardial infraction with ventricular tachycardia ?

Answer 2

lidocaine thorugh iv - class 2

adr
CNS excitation: nervousness, agitation
CNS depression- respiratory depression
headache , dizziness
tinnitus 

amiodarone - class 3 
peripheral phlebitis , 
long term - pulmonary fibroiis , thyroid abnormalities

Question 3

what is the management with atrial fibrillation ?

Answer 3

digoxin

gynecomastia , dizziness and changes in mood

Question 4

AV branch block 1st degree treatment

Answer 4

1st degree is monitoring

Question 5

ІІ degree Wenckebach type significant bradicardia treatment

Answer 5

atropine - antimuscuranic

dry mouth, large pupils , urinary retention

if no effect - temporary electrocardiostimulation

Question 6

ІІ degree type Mobitz II and III degree AV block in combination with HR bellow 40/min or hypotension or heart failure treatment ?

Answer 6

Temporary electrocardiostimulation

Question 7

heart failure can occur if the myocardial infraction is large has what treatment

Answer 7

mild and moderate heart failure - furosemide
result not sufficient fusion with nitroglycerin

if sever heart failure to shock - give oxygen therapy
follow up by blood gas analysis
presence of hypotension - reduced kidney perfusion - dopamine and
pulmonary congestion - dobutamine

Question 8

is papillary muscle rupture or valvular problems ?

Answer 8

surgery

Question 9

if there is septal rupture ?

Answer 9

surgery

Question 10

rupture of the myocardium treatment ?

Answer 10

surgery

Question 11

how does hypertensive crisis occur in acute myocardial infraction

Answer 11

autonimc nervous system activated - leading to tachycardia and vascocnsitricton

furosemide given