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FA - Cardiovascular > Cardio15 > Flashcards

Cardio15 Flashcards

Evolution of MI

1
Q

What are the most common coronary artery occlusion sites?

A

Left Anterior Descending - 1st
Right Coronary Artery - 2nd
Circumflex Artery - 3rd

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2
Q

What are the symptoms of MI?

A 
Diaphoresis
Nausea/Vomiting
Retrosternal Pain
Pain in left arm and/or Jaw
SOB
Fatigue
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3
Q

Evolution of MI: 0-4 hours

  • Light Microscopy:
  • Risk:
A

Evolution of MI: 0-4 hours

  • Light Microscopy:
    • NONE
  • Risk:
    • Arrythmia
    • CHF exacerbation
    • Cardiogenic shock
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4
Q

Evolution of MI: 4-12 hours

  • Light Microscopy:
  • Risk:
A

Evolution of MI: 4-12 hours

  • Light Microscopy:
    • Early Coagulative Necrosis
    • Edema
    • Hemorrhage
    • Wavy fibers
  • Risk:
    • Arrhythmia
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5
Q

Evolution of MI: 12-24 hours

  • Light Microscopy:
  • Risk:
A

Evolution of MI: 12-24 hours

  • Light Microscopy:
    • Contraction bands (d/t reperfusion injury)
    • Release of Necrotic cell content into Blood
    • NEUTROPHIL infiltration (begins)
  • Risk:
    • Arrythmia
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6
Q

Evolution of MI: 1-3 days

  • Light Microscopy:
  • Risk:
A

Evolution of MI: 1-3 days

  • Light Microscopy:
    • Extensive COAGULATION NECROSIS
    • Acute inflammation (tissue surrounding infarct)
    • NEUTROPHIL migration
  • Risk:
    • Fibrinous pericarditis
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7
Q

Evolution of MI: 3-14 days

  • Light Microscopy:
  • Risk:
A

Evolution of MI: 3-14 days

  • Light Microscopy:
    • MACROPHAGE infiltration
    • GRANULATION tissue at margins
  • Risk:
    • Free wall rupture leading to TAMPONADE
    • Papillary muscle rupture
    • Ventricular aneurysm
    • Interventricular septal rupture (d/t Macrophages degradation of structural components)
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8
Q

Evolution of MI: 2 weeks-months

  • Light Microscopy:
  • Risk:
A

Evolution of MI: 2 weeks-months

  • Light Microscopy:
    • Contracted scar complete
  • Risk:
    • Dressler’s syndrome
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9
Q

When do you see wavy fibers?

A

4-12 hours post-MI

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10
Q

When do you see Contraction bands?

A

12-24 hours post-MI

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11
Q

When do you see Coagulation necrosis?

A

1-3 days post-MI

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12
Q

When do you see neutrophil migration?

A

1-3 days post-MI (begins 12-24 hours post)

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13
Q

When do you see macrophage infiltration?

A

3-14 days post-MI

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14
Q

Why is there referred pain to neck and shoulder region during an MI?

A

Afferent pain fibers of Heart enter the Posterior Horn of spinal cord @ same level as brachial plexus

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15
Q

What is the gold standard for diagnosing an MI?

A

ECG - within first 6 hours

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16
Q

hat is the most specific protein marker found in blood following an MI?

A

Cardiac troponin I

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17
Q

When do you see a rise in Cardiac troponin I?

A

4 hours post-MI

Remains elevated for 7-10 days

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18
Q

What protein marker is useful in diagnosing reinfarction following acute MI?

A

CK-MB
-Levels return to normal after 48 hours

*predominantly found in myocardium but can also be released from skeletal muslce

19
Q

What are types of infarct?

A

Transmural & Subendocardial

20
Q

What are the ECG changes in a Transmural infarct?

A

ST Elevation

Q waves

21
Q

What are the ECG changes in Subendocardial infarcts?

A

ST Depression

22
Q

Describe Transmural infarct.

A

INcreased necrosis
Affects entire wall

ST Elevation & Q waves on ECG

23
Q

Describe Subendocardial infarcts.

A

d/t Ischemic Necrosis of <50% of ventricle wall
*Subendocardium especially vulnerable to ischemia

ST Depression on ECG

24
Q

ECG diagnosis of MI: Anterior Wall

  • Artery:
  • Leads w/Q waves:
A

ECG diagnosis of MI: Anterior Wall

  • Artery: LAD
  • Leads w/Q waves: V1-V4
25
Q

ECG diagnosis of MI: Anteroseptal

  • Artery:
  • Leads w/Q waves:
A

ECG diagnosis of MI: Anteroseptal

  • Artery: LAD
  • Leads w/Q waves: V1-V2
26
Q

ECG diagnosis of MI: Anterolateral

  • Artery:
  • Leads w/Q waves:
A

ECG diagnosis of MI: Anterolateral

  • Artery: Left Circumflex A.
  • Leads w/Q waves: V4-V6
27
Q

ECG diagnosis of MI: Lateral Wall

  • Artery:
  • Leads w/Q waves:
A

ECG diagnosis of MI: Lateral Wall

  • Artery: Left Circumflex A.
  • Leads w/Q waves: I, aVL
28
Q

ECG diagnosis of MI: Inferior Wall

  • Artery:
  • Leads w/Q waves:
A

ECG diagnosis of MI: Inferior Wall

  • Artery: Right Coronary A.
  • Leads w/Q waves: II, III, aVF
29
Q

Infact of the LAD affects what region of the heart?

A

Anterior wall or

Anteroseptal

30
Q

Infarct of the Left Circumflex A. affects what region of the heart?

A

Anterolateral or

Lateral wall

31
Q

Infarct of the Right Coronary A. affects what region of the heart?

A

Inferior wall

32
Q

Leads V1-V4 w/ Q waves.

A

Anterior wall (LAD)

33
Q

Leads I, aVL w/ Q waves.

A

Lateral wall (LCX)

34
Q

Leads V1-V2 w/ Q waves.

A

Anteroseptal (LAD)

35
Q

Leads II, III, aVF w/ Q waves.

A

Inferior wall (RCA)

36
Q

Leads V4-V6 w/ Q waves.

A

Anterolateral (LCX)

37
Q

What are the complications post-MI?

A
  • Cardiac Arrhythmia
  • Cardiogenic shock
  • Ventricular free wall rupture
  • Ventricular aneurysm formation
  • Postinfarction fibrinous pericarditis
  • Dressler’s syndrome
38
Q

MI complication: Cardiac arrhythmia

A

Important cause of death before reaching hospital

  • common in first few days
  • LV failure and Pulmonary Edema
39
Q

MI complication: Cardiogenic shock

A

Large infarct – High risk of mortality

40
Q

MI complication: Ventricular free rupture

A 
Cardiac tamponade:
1-Papillary muscle rupture
2a-Severe mitral regrugitation
2b-Interventricular septum rupture
3-Ventricular Septal Defect
41
Q

MI complication: Ventricular aneurysm formation

A
  • DEcreased CO
  • Risk of arrhythmia
  • Embolus from mural thrombis

*Greatest risk approx. 1 week post-MI

42
Q

MI complication: Postinfarction fibrinous pericarditis

A

Friction rub (1-3 days post-MI)

43
Q

What is Dressler’s syndrome?

A

Autoimmune phenomenon resulting from fibrinous pericardidits

*several weeks post-MI

FA - Cardiovascular (17 decks)

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