AMI

Question 1

Drug of choice for patients with AF assoc with MI who do not respond to cardioversion

Answer 1

Amiodarone; Betablocker

Question 2

Beta blocker can be used for rate control for patients with on-going ischemia without the following: Give 4

Answer 2

HAHA
H - hemodynamic compromised (Hypotension)
A - reactive airway (ASTHMA)
H - LV Dysfunction (HF)
A - heart block (AV block)

Question 3

most prominent conduction disturbance/dysrhythmia in anterior wall MI

Answer 3

Sinus Tachy

Question 4

True/False: Sinus Bradycardia with hypotension doesn’t increase mortality during AMI

Answer 4

FALSE: Sinus Bradycardia WITHOUT hypotension doesn’t increase mortality during AMI

additional info
Atropine is used for sinus bradycardia when it results in hypotension, ischemia, or ventricular escape rhythms and for treatment of symptomatic atrioventricular block occurring at the atrioventricular nodal level (e.g., second-degree type I). Atropine can improve heart rate, systemic vascular resistance, and blood pressure; use it with caution in the setting of AMI since the parasympathetic tone is protective against infarct extension, ventricular fibrillation, and excessive myocardial O2 demand.

Question 5

True or false

New right bundle branch block occurs in <10% of patients with AMI and is also associated with a higher mortality than in patients without right bundle branch block.

Answer 5

FALSE

New right bundle branch block occurs in approximately 2% of AMI patients, most commonly with anteroseptal AMI; it is associated with increased mortality and complete atrioventricular block.

New left bundle branch block occurs in <10% of patients with AMI and is also associated with higher mortality than in patients without left bundle branch block.

Question 6

History of medication to ask before starting Nitroglycerin

Answer 6

PDE inhibitors
Sildenafil - 24 hours
Tadalafil 48 hours

Question 7

This drug produces
1. Systemic and coronary vasodilation
2. Possesses antiplatelet activity
3. Suppresses automaticity
4. Protects myocyte from calcium influx during reperfusion

Answer 7

Magnesium

Though still with conflicting data. During AMI, you may give Mg for cases of Torsades de pointes-type VTach or if with prolonged QTi

Question 8

In patients presenting AMI, the appearance of new holosystolic murmur means the presence of

Answer 8

rupture of the Interventricular septum.

This is more often detected clinically than rupture of ventricular free wall.

Also, Doppler echo is the diagnostic procedure of choice

Question 9

TRUE/FALSE: Discomfort of Pericarditis becomes worse with deep inspiration and may relieved by sitting forward

Answer 9

TRUE:Discomfort of Pericarditis becomes worse with DEEP INSPIRATION and may relieved by SITTING FORWARD

Question 10

When do we start inotropic support in the setting of RV infarction with reduced CO and hypotension?

Answer 10

if CO didn’t improve after 1 to 2L of normal saline

Question 10

T/F: Ibuprofen is the treatment of choice for AMI with Pericarditis

Answer 10

False

Ibuprofen interferes with the antiplatelet activity of aspirin and cause myocardial scar thinning and infarct expansion

Treatment is symptomatic with aspirin, 650 milligrams PO every 4 to 6 hours, or colchicine, 0.6 mg twice daily.

Question 11

Use of this drug to reduce afterload may be of benefit when RV infarction is accompanied by LV dysfunction

Answer 11

Nitroprusside

When right ventricular infarction is accompanied by left ventricular dysfunction, the use of nitroprusside to reduce afterload or intra-aortic balloon counterpulsation may be of benefit. Reduction in left ventricular afterload may help passive movement of blood through the right ventricle. pg 351

Question 12

This medication is contraindicated for patients with cocaine-associated MI in the first 24 hours

Answer 12

betablockers