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OSCE related > Case Files: MI > Flashcards

Case Files: MI Flashcards

1
Q

Diagnoses that may mimic acute MI but will not benefit by anticoagulation or Thrombolysis

A

Acute pericarditis, aortic dissection

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2
Q

Examples of thrombolytics?

A

Tissue plasminogen activator, streptokinase, reteplase

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3
Q

MI chest pain can radiate to?

A

Arm, Lower jaw, neck

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4
Q

NSTEMI vs STEMI?

A

Incomplete vessel occlusion (only subendocardium affected) vs transmural

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5
Q

MI symptoms in a diabetic older than 70?

A

Painless discomfort associated with dyspnea, pulmonary edema, ventricular arrhythmias

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6
Q

S4 gallop associated with an MI suggests?

A

Myocardial noncompliance because of ischemia

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7
Q

S3 gallop in the presence of MI represents?

A

Severe systolic dysfunction or

Mitral regurgitation caused by ischemic papillary muscle dysfunction

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8
Q

ECG changes in an acute MI?

A

Tall, positive, hyperacute T waves

ST segment elevation

T-wave inversion (hours to days)

Diminished R wave amplitude (Q waves)

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9
Q

Q waves represent?

A

Myocardial necrosis and replacement by scar tissue

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10
Q

Persistent ST segment elevation represents?

A

Left ventricular aneurysm

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11
Q

Leads that correspond to the anterior surface of the heart? Supplied by which artery?

A

V2-V4. LAD

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12
Q

Leads to correspond to the inferior surface of the heart? Supplied by which artery?

A

II, III, aVF. RCA

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13
Q

Leads that correspond to the lateral surface of the heart? Supplied by what artery?

A

I, aVL, V5, V6. LCX.

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14
Q

Cardiac enzymes and when they rise

A 
Troponin I (6 hours to 7-10 days)
Troponin T (6 hours to 10-14 days)
CK-MB (4-8 hours to 2-3 days)
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15
Q

Rule out MI if?

A

Two sets of normal troponin levels 4 to 6 hours apart

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16
Q

The diagnosis of acute MI if two of the following:

A
  1. Chest pain persisting for more than 30 minutes
  2. atypical ECG findings
  3. elevated cardiac enzyme levels
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17
Q

Aortic dissection presents with what findings? (Not MI symptoms)

A
  1. Unequal pulses and blood pressures in the arms
  2. New murmur of aortic insufficiency
  3. Widened mediastinum
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18
Q

Acute pericarditis often presents with?

A
  1. Chest pain
  2. pericardial friction rub
  3. Diffuse ST segment elevation
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19
Q

Patient with acute MI. What antiplatelet agents are given?

A

Aspirin, heparin

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20
Q

Patient with acute MI. What drugs are given to limit infarct size (and how)?

A
  1. Beta blockers are used to decrease myocardial oxygen demand and 2. nitrates are given to increase coronary bloodflow
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21
Q

Morphine may be given to patients with acute MI to?

A
  1. Reduce pain

2. reduce tachycardia

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22
Q

Maximal benefit of thrombolytics if given within? Major risk? Risk outweighs the benefit when?

A

1-3 hours. Bleeding. After 12 hours.

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23
Q

Thrombolytic therapy is indicated if all of the following criteria are met:

A
  1. Clinical complaints are consistent with ischemic type chest pain
  2. ST segment elevation more than 1 mm in at least two anatomically contiguous leads
  3. No contraindications
  4. Patient is younger than 75 years
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24
Q

Contraindications for thrombolytics?

A

Recent major surgery, aortic dissection, Pregnancy, Uncontrolled hypertension

25
Q

Percutaneous coronary intervention?

A

Angioplasty and stenting

26
Q

Percutaneous coronary intervention vs Thrombolysis

A

Provides greater survival benefit and lower risk of serious bleeding

27
Q

Percutaneous coronary intervention can be used in these patients who would gain no survival benefit from thrombolytic therapy

A

Hypotensive, cardiogenic shock

28
Q

Mortality in acute MI is usually a result of?

A
  1. Myocardial pump failure and resulting cardiogenic shock

2. ventricular arrhythmias

29
Q

These complications of acute MI usually occur within the first 24 hours? Treat with?

A

Ventricular tachycardia and ventricular fibrillation. Treat with direct-current cardioversion followed by intravenous antiarrhythmics such as amiodarone

30
Q

Ventricular tachycardia ventricular fibrillation are life-threatening because?

A

Prevent ventricular contraction leading to pulseless and cardiovascular collapse

31
Q

Benign ventricular arrhythmia is not suppressed by antiarrhythmics after an acute MI. Description of rhythm?

A

Accelerated idioventricular rhythm. Wide complex escape rhythm between 60 and 110 BPM that accompanies reperfusion

32
Q

Sinus bradycardia is frequently seen after what type of MI? Treatment?

A

Inferior MI because the right coronary artery supplies of the sinoatrial node. No treatment unless it causes hypotension in which case, treat with atropine

33
Q

Examples of AV conduction disturbances? Treatment?

A

First-degree AV block, Mobitz I second degree AV block

Tx: atropine

34
Q

AV conduction disturbances caused below the AV node? Treatment?

A

Mobitz II second degree AV block, third degree AV block, left bundle branch block, right bundle branch block. Treat with pacemaker.

35
Q

Most severe form of left ventricular pump failure?

A

Cardiogenic shock

36
Q

Patients with pulmonary hypertension are evaluated by?

A

Pulmonary artery (Swan-Ganz) catheterization.

37
Q

Diagnosis of cardiogenic shock if?

A
  1. Systolic arterial pressure less than 80.
  2. Markedly reduced cardiac index less than 1.8
  3. Elevated left ventricular filling pressure greater than 18
38
Q

Findings in patient with cardiogenic shock?

A

hypertension, cold extremities, pulmonary edema, elevated jugular venous pressure

39
Q

Findings in patient after right coronary artery occlusion and inferior infarction?

A

Right ventricular infarction

  1. Hypertension,
  2. elevated JVP
  3. clear lung fields,bno pulmonary edema
  4. ST segment elevation in a right-sided EKG
40
Q

Treatment of right ventricular infarction?

A

Volume replacement with saline or colloid solution

41
Q

Do not give these types of drugs to patients with right-sided ventricular infarction?

A

Patients need to increase preload. Do not give diuretics or nitrates

42
Q

Papillary muscle dysfunction is a complication of what type of infarction? Can lead to?

A

Left ventricular infarction. Can lead to mitral regurgitation

43
Q

Development of acute heart failure and shock in association with a new holosystolic murmur suggests?

A

Ventral septal rupture

44
Q

Most catastrophic mechanical complication of infarction? Leads to?

A

Ventricular wall rupture. Leads to cardiac tapenade

45
Q

If ST segment elevation persists weeks after MRI, think?

A

Ventricular aneurysm

46
Q

Treatment of Dressler syndrome?

A

Anti-inflammatory drugs, including NSAIDs and prednisone

47
Q

Post MI risk stratification protocol?

A
  1. Submaximal exercise stress testing to detect residual ischemia
  2. Evaluation of left ventricular systolic function with echocardiography
48
Q

Post MI patients with severe left ventricular dysfunction are at an increased risk for? May benefit from?

A

Sudden cardiac death from ventricular arrhythmias. May benefit from implantable cardioverter-defibrillator

49
Q

Most important risk factor for secondary MI?

A

Smoking cessation reduces risk by more than 50%

50
Q

Drug most important for post MI patients with impaired systolic function, diabetes or hypertension?

A

ACE inhibitors

51
Q

Unstable angina - mech?

A

Alternating patterns of Thrombus formation and dissolution

52
Q

MI, Unstable angina, Chronic stable angina. Treat with?

A

All three - ASA and anti platelets

Heparin - UA and MI

tPA - MI

53
Q

Chance of hemorrhage stroke in pt with unstable angina?

A

1%

54
Q

CABG?

A

Coronary bypass

55
Q

If inferior wall ischemia, effect on HR?

A

Ischemia to AV node or vegas nerve stimulation

56
Q

60 y/o pt with inferior wall ST depression. HR:58, BP: 122/77 Tx?

A

ASA
O2
Nitroglycerin
B-blocker (don’t give if HR<50)
(Anti-platelet, but small absolute benefit)
Heparin (but commits you to go to cath lab)

57
Q

Pt becomes hypotension with cardiac ischemia treatment - next steps?

A

Can’t give b-blocker
Give heparin
If give heparin, need to go to cath lab

58
Q

EKG shows with acute ST segment elevation MI. Next step in therapy?

A

Aspirin and beta blocker. Assess whether he is a candidate for rapid reperfusion (thrombolytics)

OSCE related (16 decks)

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