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XIO > AMI > Flashcards

AMI Flashcards

1
Q

ACS ACUTE CORONARY SYNDROME
(ACUTE MYOCARDIAL INFARCTION) (it’s in the name)

A

Lack of oxygen to myocardium causing necrosis

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2
Q

What is the most common cause of Acute Coronary Syndrome??

A

Atherosclerosis

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3
Q

patho

A

Normal vessel
Lipid (cholesterol core starts) around the lumen
Large lipid core forms and becomes Atherosclerosis
Note - diameter is smaller.
Fibrous cap thins (capsule where the cholesterol is)

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4
Q

CAD: AMI PATHOPHYSIOLOGY (cap the AMI)

A

Atherosclerotic plaque develops in coronary vessel
Vessel narrows
Fibrous cap thins
Cap tears & ruptures
Blood clot forms and occludes blood vessel

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5
Q

Thin fibrous cap develops

A

fissure/tear and ruptures
Thrombus immediately forms and occludes the vessel

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6
Q

CLINICAL SIGNS AND SYMPTOMS OF AMI - pain on what side? where does it radiate? (NJAB a heart attack)

A

Left chest pain. Not relieved by rest or nitro
Described as heaviness, tightness, constricting, crushing pain in the sternal area.
May radiate to the neck, jaw, arms, or back.

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7
Q

Signs and Symptoms of Women and CAD

A

CAD is the number 1 killer of American Women
Women manifest sx’s of CAD 10 yrs later than men
Treadmill test less sensitive in women (35% false +)
Exercise echocardiogram more accurate in women
Women have a 42% chance of dying 1 yr after MI (vs) men who have a 23% chance - has to do w/ not catching it in time w/ women

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8
Q

Diagnostic Work up for AMI (same for CAD)

A

HPI (history) c/w AMI
Adult c/o left chest pain
Serial ECG’s
Serial Troponin levels (CK MB)

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9
Q

EKG’s

A

Serial EKG 75 - 80% specific for diagnosing MI’s.
Only 50% of initial EKG’s are abnormal*** that’s why we need cereal EKGs
Demo… 12 lead EKG

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10
Q

PQRST (won’t test on EKGs)

A

P= atrial depolarization / contraction

QRS = Vent depolarization /contraction (QRS is ischemia)

ST = repolarization of Vent

Atrial repolarization during QRS

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11
Q

12 lead ECG c/w acute MI - elevation? (the number)

A

ST elevation > 1mm in at least 2 consecutive leads

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12
Q

EKG CHANGES - are they immediate?

A

IMMEDIATE
STEMI (ST elevation MI)
S-T segment ↑ in leads over the infarct

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13
Q

Note: 75% of all MI’s are in which ventricle?

A

Left Ventricle

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14
Q

LAB TESTS FOR AMI (just the main one)

A

enzymes & proteins are released from dead cardiac cells, that ‘s where TROPONINs come from. some ppl have naturally elevated troponin - so re-check a few hours later if high.

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15
Q

CAD: DIAGNOSTIC TESTS – SERUM MARKERS AFTER AN ACUTE MI - CK-MB (crete is 6, 15, 3)

A

Serum Marker First appears
CK-MB 4 – 6 hrs
Peaks 15 – 24
Normalizes 3 – 4 days

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16
Q

COMPLICATIONS OF AMI - most common one

A

ARRHYTHMIA’s (Most common complication)
80% of MI’s go into ARRHYTHMIA’s: such as:

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17
Q

(may precede V-Tach, V-fib)- COMPLICATIONS OF AMI - PVCs may precede…

A

(may precede V-Tach, V-fib

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18
Q

COMPLICATIONS OF AMI- Cardiogenic shock - what % of loss of function?

A

assoc with > 40% loss of Left Ventricle function.

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19
Q

GOALS OF TREATMENT FOR AMI

A

Preserve Myocardium (reperfusion)
Control pain
Manage and prevent complications
Cardiac Rehabilitation

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20
Q

ACS Chest Pain Protocol - Symptoms suggest MI CHEST PAIN, what do you do? (time…)

A

Activate EMS (Emergency Med System)
Time CP (chest pain) began (< 12 hrs or > 12 hrs?)
ABC’s, VS, CPR, Defibrillation
Cardiac Monitor
IV access, Labs (Troponin, Coags, lytes, CBC, Chem..)
Focused Exam, Hx, Fibrinolytic Checklist
Initiate ED TX MONA BT
If STEMI < 12 hr.. (ST Elevation Myocardial Infarct)

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21
Q

MONA B + (and how much?)

A

O2 4L/min np
ASA 160 to 325mg chew tablet
Nitro SL 0.4 q5min X 3 doses (Caution - don’t give nitro w/ an inferior MI can cause hypotension)
Morphine if pain not relieved with NTG
Beta Blocker (Metropolol 5mg to 15mg)
PCI/Thrombolytics

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22
Q

BEST OUTCOMES WITH PCI - when can you use it?

A

Percutaneous coronary intervention with angioplasty and stent (preferred treatment for ST-elevation MI) (for a STEMI less than 12 hours***)
Start MONA B
Treat or transfer to hospital with PCI capability
Door to Balloon < 90min

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23
Q

PCI WITH PTCA

A

Percutaneous Coronary Intervention with Percutaneous Transluminal Angioplasty with Stent

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24
Q

If PCI NOT Available AND CP (chest pain) is < 12 HOURS, give…

A

THROMBOLYTICS, an
IV Medication that dissolves the Blood Clot
Reduces mortality ↓ 2.5 – 5%
Must be used with CP less than 6-12 hours
Goal: Door to Needle less than 30 min

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25
Q

What if it the patient has had Chest Pain for more than 6 to 12 hours??

A

Need to consult with Cardiology

26
Q

AMI > 12 hours - STABLE MI - what meds (ace is older than 12 hours)

A

Admit CCU, Continuous Monitoring
Ace Inhibitor, Morphine, beta blocker, NTG
Echocardiogram

27
Q

AMI > 12 hours - UNSTABLE MI (the cabbage is severe)

A

Possible..Cardiac Cath
Possible PCI or CABG (Coronary Artery Bipass graft)
Possible IABP (Intra-aortic balloon pump)

28
Q

MEDICATIONS for AMI - ASA

A

160 – 325mg (best to chew tablet)
23% reduction in 30-day mortality
In patients with unstable angina yields 50% reduction in mortality.
(Thrombolytics 2.5 - 5 % reduction)

29
Q

MEDICATIONS for AMI - heparin (everyone loves hepburn)

A

Should be used in all suspected AMI’s without contraindications
2.4% reduction in death
Also given to pts who get Thrombolysis tx.

30
Q

meds for AMI - morphine (how much)

A

↓ Pain, anxiety, ↓ cardiac workload
1 – 5 mg q 5 minutes until pain controlled. (√ hypotension, ↓RR)

31
Q

meds for AMI - nitro - what does it do? (nitro before and after)

A

↓ Pain, ↓ preload and afterload
0.3 – 0.4 SL (subligual or Nasal q 5 min X 3 doses then IV 10 – 20mcg/min

32
Q

meds for AMI - Antiarrhythmics (Mi Am a Pro Lid)

A

prn (Amiodarone, Lidocaine, Procainamide..)

33
Q

meds for AMI - Beta Blocker - what do they do? (not HR, but…)

A

Metoprolol (Lopressor)
Give in ED, ↓ pulse and O2 demand
↑ survival rate (saves 1 in 140 lives) IV/ PO

34
Q

meds for AMI - ACE inhibitors - when to start? and for how long? (6 Aces)

A

Start within 6 - 12 hrs of MI and continue for at least 6 weeks.
Studies show better survival rates

35
Q

Treat arrhythmias - when to defib?

A

Defibrillate
V-fib, and pulseless V-Tach

36
Q

SUDDEN CARDIAC DEATH - usually from what?

A

Sudden Cardiac Arrest and Death usually from V Fib during AMI
In spite of aggressive CPR in the field, few who develop out-of-hospital cardiac arrest will survive.

37
Q

ETIOLOGY of Sudden Cardiac Death - what does it usually start with? (sudden cardiac death is tacky)

A

Most pts have pre-existing multi-vessel dz
75% have occlusive atherosclerosis
Sudden Cardiac arrest usually begins with V-Tach to V-Fib, then Asystole.

38
Q

Sudden Cardiac Death - medical management

A

DEFIBRILLATION

39
Q

CAD: FACTS ABOUT SUDDEN CARDIAC ARREST - what do they die from? (Gabrielle has Sudden cardiac death)

A

ALMOST ALL PEOPLE WITH SUDDEN CARDIAC ARREST DIE FROM V-FIB.
FROM THE TIME A PERSON GOES INTO CARDIAC ARREST UNTIL THEY ARE DEFIBRILLATED IS CRUCIAL TO THEIR SURVIVAL RATE.
90% SURVIVAL RATE IF DEFIB IN 1 MINUTE FROM ARREST
10% SURVIVAL RATE IF DEFIB AFTER 9 MINUTES

40
Q

most dangerous plague is a

A

thin fibrous cap and large lipid core

41
Q

20 minutes after ischemia (die in 20 min)

A

necrosis begins in the heart

42
Q

Non-stemi

A

non ST elevated MI

43
Q

troponin T - levels (T is a very low 1)

A

normal is less than 0.01. MI is 0.1

44
Q

troponin I - levels (I am just a zero less)

A

normal less than 0.1. MI is 1.

45
Q

if MI is suspected…door to balloon time and door to needle time

A

Door to Balloon (PCI with Stent) 90 min for Percutaneous Coronary Intervention -OR-
Door to Needle (Fibrinolytics) 30 min

46
Q

if PCI is not available…

A

start Fibrinolytics w/in 30 min

47
Q

memorize slide

A

41 ACS powerpoint

48
Q

AMI - symptoms - when does it occur? how long does it last? (Am I having a heart attack for 20 min?)

A

Can occur while active or at rest
Usually lasts longer than 20 minutes or >

49
Q

AMI - stomach issues?

A

Associated sx’s: N/V, diaphoresis, anxiety
Can present atypically especially in woman, diabetics and the elderly. - know something is wrong, but can’t really describe it.
GI upset
mid to upper back pain
indigestion

50
Q

AMI - breathing?

A

SOB

51
Q

diagnostics for AMI - CONSIDER

A

Portable CXR (chest x-ray) to check for (Aneurysms, PE, CHF)
Cardiac Cath, coronary angiography (isolate the occlusion)

52
Q

EKG - Areas of ischemia and infarct can be noted on the EKG where? (all of them)

A

lateral, anterior, posterior, inferior….

53
Q

EKG - Area of infarct can correlate with the possible complications like

A

CHF, arrythmias, cardiogenic shock..
3-5 leads are not enough

54
Q

EKG w/ MI - NSTEMI - what will be elevated?

A

NSTEMI Non-ST elevation MI Troponins will be elevated
(double check placement if you only see elevation in one lead)

55
Q

diagnostics after an acute MI - Troponin I (isn’t normal right away basically)

A

Serum Marker First appears
Troponin I 3 – 6 hrs Peaks 14 - 18
Normalizes 5 – 7 days

GET SERIAL TROPONIN LEVELS and SERIAL ECG’S

56
Q

complications of AMI - what types of arrhythmias (AMIs can go either way)

A

Tachycardia
Bradycardia
Heart Block

57
Q

If no PCI available…(fiber to the rescue)

A

use Fibrinolytics (t-PA)

58
Q

when is nitro contraindicated? (Nitro is not right, it’s inferior)

A

Contraindicated in right vent infarct
Suspect if Inferior MI and get Right sided EKG

59
Q

when are beta blockers contraindicated?

A

Contraindicated in CHF, hypotension, bradycardia, HB

60
Q

arrhythmias - what meds? (Octavia arrhythmias)

A

Amiodarone, Lidocaine

XIO (393 decks)

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