CIS Myocardial Infarction (Johnston)

Question 1

Sympathetic hyperactivity (increase HR, increase BP) is usually seen in ___ MI

Answer 1

Anterior

Question 2

Parasympathetic activity (bradycardia, decreased BP) is usually seen in ___ MI

Answer 2

Inferior

Question 3

Describe the EKG findings and cardiac enzymes in NSTE ACS:

Answer 3

ST depression, T wave inversion with chest pain

Normal cardiac enzymes

Question 4

When do you see Q waves?

Answer 4

Infarction –> Dead tissue, lacks depolarization

Question 5

What do ST segment shifts (elevation or depression) indicate?

Answer 5

Myocardial injury –> deficient blood supply, inability to fully polarize

Question 6

T wave changes such as T wave inversion indicate __

Answer 6

Ischemia –> deficient blood supply, impaired repolarization

Question 7

Anterior wall infarctions are associated with which artery and which leads?

Answer 7

LAD

V1-V7

Question 8

Inferior wall infarctions (RV infarction) is associated with what artery and which leads?

Answer 8

RCA

II, III, aVF, V3R-V6R

Question 9

Lateral wall infarctions are associated with which artery and what leads?

Answer 9

Circumflex

I, aVL, V5-V6

Question 10

Posterior wall infarctions are associated with which artery and which leads?

Answer 10

Posterior descending artery

V1-V3

Question 11

What leads will you look at for a true posterior infarct and what will they show?

Answer 11

Since no ECG lead reflects posterior electrical forces, changes are reciprocal of those in anterior leads. Lead V1 shows unusually large R wave (reciprocal of posterior Q wave) and upright T wave (reciprocal of posterior T wave inversion)

Question 12

What would you see in the following labs after an MI:

• WBCs:
• CRP:
• BNP:

Answer 12

Increased WBC (hrs to 2-4 days)
Increased CRP
BNP increased in ventricular wall stress and fluid overload

Question 13

The majority of deaths related to AMI occur within 1 hr of onset of symptoms and most deaths are related to ___

Answer 13

V fib

Question 14

What is the E.D. Standard of care for a STEMI?

Answer 14

12 lead ECH with continuous cardiac monitoring
IV lines inserted
Cardiac enzymes (cTnI), CBC, CMP, PT, PTT

Question 15

What do you want to do for reperfusion strategy in STEMI?

Answer 15

Primary percutaneous coronary intervention (PCI) with angioplasty and stunting
Cath lab within 90 mins (goal)

Question 16

When do you ideally want to begin fibrinolysis in STEMI in the ED?

Answer 16

Within 30 minutes

Question 17

Primary PCI is preferred for STEMI with symptoms less than __ hours

Answer 17

12

Lower mortality rate and intracerebral hemorrhage

Question 18

What is a major risk for for fibrinolytic therapy in a STEMI or new left BBB within 12 hrs of onset of symptoms?

Answer 18

Intracerebral hemorrhage

Question 19

What can you give for initial medical management for a STEMI?

Answer 19

Aspirin - given on presentation unless contraindicated

Question 20

This drug can relieve vasoconstriction; relieve pain (chest), reduce pre and afterload

Answer 20

Nitroglycerin

Question 21

When do you not want to give a B blocker for a pt with a STEMI?

Answer 21

Dont use in decompensated HF, decreased HR, decreased BP

Question 22

What can you give to a pt who has acute pericarditis after an MI?

Answer 22

Aspirin

NSAID

Question 23

What sort of rhythm disturbances can occur following an MI?

Answer 23

V fib (Rx elective cardioversion)
Catch
Polymorphic V tach
V flutter

Question 24

This benign arrhythmia can occur following fibrinolytic therapy:

Answer 24

Accelerated idioventricular rhythm (AIVR)

Question 25

Sinus bradycardia is associated with an __ MI (up to 40% pts)

Answer 25

Inferior

Question 26

Second degree AV block Wenckebach is associated with __ MI

Answer 26

Inferior wall

Question 27

____ is the leading cause of hospital death from AMI

Answer 27

Heart failure

Question 28

Acute mitral valve regurgitation can occur following an MI as a complication d/t

Answer 28

Rupture or dysfunction of papillary muscle

Question 29

A new holosystolic murmur is a mechanical complication following an MI associated with a ___ MI

Answer 29

Inferior wall

Need surgery

Question 30

Septal rupture with Ventricular septal defect is associated with an __ MI

Answer 30

Anterior wall

Question 31

LV free wall rupture can cause __

Answer 31

Tamponade

Question 32

LV aneurysm is associated with an __ MI

Answer 32

Anterior

Question 33

Most MIs are caused by this underlying condition:

Answer 33

Atherosclerosis