6 Acute Coronary Syndrome, part 4 Flashcards
Most common tachydysrhythmias in AMI
*Ventricular premature beats (99%)
Accelerated idioventricular rhythm (50-70%)
Ventricular tachycardia, nonsustained (60-69%)
* PVCs are benign
Most common bradydysrhythmia in AMI
Sinus bradycardia
Atropine is used for
Sinus bradycardia when it results in hypotension, ischemia, or ventricular escape rhythms and for treatment of symptomatic AV block occurring at the AV nodal level (e.g., second-degree type I).
remarks on compete heart block
Complete heart block in the setting of an anterior myocardial infarction portends a grave prognosis
Sudden decompensation of previously stable AMI patients should raise concern for
mechanical complications of AMI
- ventricular free wall ruptrue
- ruptrue of the IV septum
- papillary muscle rupture
Remarks on ventricular free wall rupture
usually 1-5 days after infarction
leads to pericardial tamponade and death (in >90% of cases)
treatment is surgical
Remarks on interventricular septum rupture
More often detected clinically.
Chest pain, dyspnea
New holosystolic murmur (LLSB) + palpable thrill
More common in anterior wall MI and extensive (3-vessel) CAD
Treatment is surgical
Remarks on papillary muscle rupture
Usually occurs 3-5 days after AMI
More coMmon with inferior wall MI
Often occurs with small- to modest-sized AMI
New holosystolic murmur - MR
Treatment is surgical
Most commonly ruptured papillary muscle
posteromedial papillary musce,
because it receives blood supply from one coronary artery,
usually the RCA
Pericarditis post-MI
Often 2-4 days after MI
Dressler’s syndrome: 2-10 weeks after MI
treatment is symptomatic
with aspirin 650 mg PO every 4-6 hours
or colchicine 0.6 mg twice daily
* Ibuprofen interferes with effect of aspirin and can cause myocardial scar thinning and infarct expansion
The most serious complication of right ventricular infarction is
shock
Remarks on postprocedure chest pain
Patients who present with symptoms of an ACS shortly after PCIs, such as angioplasty or stent placement, should be assumed to have had abrupt vessel closure, until proven otherwise
Mainstays of traetment for initial stabilization of cocaine- or amphetamine- related AMI
Aspirin, nitrates, and benzodiazepines
Beta blockers are contraindicated in the first 24 hours
ACS and GI bleed
In general, treatment of the GI bleed takes priority, which precludes the major treatments for AMI. 📌
ACS and Sepsis
Approximately 50% of patients with severe sepsis and septic shock have impairment of LV systolic function, frequently with an elevated troponin level.
