Acute MI Flashcards
what are the symptoms of AMI? (3)
pressure-like chest pain
more than 20 mins
radiation to jaw, neck, shoulders, arms
what are the 2 characteristics of a STEMI?
ST elevation
elevations in cardiac enzymes
what is commonly caused by advanced atherosclerotic plaque with thrombosis that is not occlusive and may be associated with increased myocardial demand?
Non-ST elevation MI (NSTEMI)
what is S3 also known as and when does it occur?
ventricular gallop - blood rushing into left ventricle
ischemia
what is S4 also known as and when does it occur?
atrial gallop (kick) - atrial kick against ventricles
heart failure
what are 4 things I may find in a physical exam for AMI?
jugular venous distention
S3 gallop with ischemia
S4 gallop with heart failure
rales, pedal edema with heart failure
what are 6 causes of acute chest pain that cause rapid mortality?
PE
spontaneous pneumothorax
unstable angina
acute MI
aortic dissection
pericardial tamponade
what 2 important symptoms would be seen in an AMI with right ventricular infarction?
elevated jugular venous pressure
Kussmaul’s sign
what is kussmaul’s sign?
drop in jugular venous pressure during inspiration
what is an important physical exam finding to indicate an AMI with rupture of the interventricular septum?
loud holosystolic murmur at the lower left sternal border + a thrill
which cardiac biomarker is elevated within hours of an AMI?
troponin
what 2 things must be present to diagnose an MI?
elevated cardiac enzymes
ECG evidence of ischemia (ST changes)
what should be ordered to evaluate the severity and myocardial function?
echocardiogram
which cardiac enzymes should be checked?
CK-MB and troponin
what should be given to patients with an AMI at presentation and continue indefinitely thereafter?
aspirin
what can be given to patients that are aspirin-sensitive?
clopidogrel
what can be given to NSTEMI patients depending on risk of morbidity/mortality?
heparin or enoxaparin
what can be given to patients to relieve ischemic chest pain?
nitroglycerin?
which patients should NOT receive nitroglycerin? (2)
hypotensive
right ventricular infarction
how should nitroglycerin be titrated?
based on blood pressure reduction, not symptoms
what should be given to all hemodynamically stable patients with an AMI?
beta blocker
what should be given to ALL patients within 24 hours after MI?
ACE inhibitor
what can be given to patients who are intolerant of ACEI?
ARB
why are ACEIs and ARBs used in situations of AMIs?
reduce incident of ventricular remodeling and heart failure
how/when is long term therapy with ACEIs or ARBs determined/indicated?
left ventricular function - for EF < 40%
what medication should be given within 14 days of AMI to reduce occurrence of unstable angina at 4 months?
statins
what is the treatment of choice for AMI?
percutaneous coronary intervention (angioplasty with stent)
in which patients should I consider a PCI? (2)
severe heart failure
symptoms for more than 3 hours
what is the door to balloon time for a primary PCI?
less than 90 mins
what 3 things make a patient a candidate for CABG?
diabetes
left main stenosis > 50%
triple-vessel involvement
what should be given within 30 minutes of medical contact when primary PCI is not available or if a delay of more than 90 mins to balloon time is expected?
fibrinolytic
what is associated with a higher risk of death after AMI?
NSAIDs
