Chapter 56: management of STEMI

Question 1

what is a myocardial infraction

Answer 1

necrosis of the myocardium resulting form ischemia

Question 2

what is STEMI

Answer 2

acute MI caused by complete interruption of regional myocardial blood flow
- causes ST segment elevation

Question 3

Diagnosis of STEMI

Answer 3

• chest pain
• elevation of ST segment on ECG
• sweating, weakness, sense of impending doom

Question 4

Biochemical markers for MI

Answer 4

• cardiac troponin I and cardiac troponin T
• MB isozyme of creatine kinase (CK-MB)

Question 5

STEMI routine drug therapy

Answer 5

• oxygen
• acetylsalicylic acid
• morphine
• beta blockers: atenolol, metoprolol
• nitroglycerin

Question 6

STEMI reperfusion therapy

Answer 6

• want to restore blood flow through the blocked coronary artery
• primary percutaneous coronary intervention (PCI) (angioplasty-stent)
• fibrinolytic (thrombolytic) therapy

Question 7

Fibrinolytic (thrombolytic) therapy goal

Answer 7

to improve ventricular function, limit size of infract, and reduce mortality

Question 8

Fibrinolytic (thrombolytic) therapy is most effects when

Answer 8

patient presents early; not given if pain has been present longer than 12 hours
- best if given during forst 4-6 hours

Question 9

timely administration of fibrinolytic (thrombolytic) therapy =

Answer 9

opening of accluded artery in 80% of patients

Question 10

what is the target time of fibrinolytic therapy

Answer 10

30 min target time

Question 11

fibrinolytic therapy is best for patients younger than

Answer 11

75 years old

Question 12

management of STEMI drugs

Answer 12

• unfractionated heprin
• low molecular weight heparin
• antiplatelet drugs

Question 13

unfractionated heparin used for treatment

Answer 13

lasting less than 48 hours

Question 14

low molecular weight heparin is used for treatment

Answer 14

loasting longer than 48 hours

Question 15

antiplatelet drug examples

Answer 15

• clopidogrel [plavix]
• GP IIb/IIb inhibitors
• low dose acetylsalicylic acid (asprin)

Question 16

Angiotensin-converting enzyme (ACE) inhibitors

Answer 16

• decrease short term mortality in all patients and long term mortality in patients with reduced left ventricular function
• reduce preload and afterload, promoting water loss and favorably altering ventricular remodeling

Question 17

ACE inhibitors is recommended

Answer 17

for all patients in the absence of specific contradictions

Question 18

treatment with ACE inhibitors should start within

Answer 18

25 hours of symptom onset

Question 19

ventricular dysrhythmias frequently develop after

Answer 19

MI

Question 20

complications of STEMI

Answer 20

• ventricular dysrhythmias
• cardiogenic shock
• heart failure and cardiac rupture can also occur

Question 21

Secondary prevention of STEMI

Answer 21

risk factor reduction
- cholesterol control, smoking cessation, exercise, blood pressure control, diabetes control

Question 22

what 4 drugs should be taken indefinitely after an MI

Answer 22

• beta blocker
• ACE inhibitor
• Antiplatelet drug/anticoagulant
• statin