CIS Myocardial Infarction (Johnston) Flashcards
Sympathetic hyperactivity (increase HR, increase BP) is usually seen in ___ MI
Anterior
Parasympathetic activity (bradycardia, decreased BP) is usually seen in ___ MI
Inferior
Describe the EKG findings and cardiac enzymes in NSTE ACS:
ST depression, T wave inversion with chest pain
Normal cardiac enzymes
When do you see Q waves?
Infarction –> Dead tissue, lacks depolarization
What do ST segment shifts (elevation or depression) indicate?
Myocardial injury –> deficient blood supply, inability to fully polarize
T wave changes such as T wave inversion indicate __
Ischemia –> deficient blood supply, impaired repolarization
Anterior wall infarctions are associated with which artery and which leads?
LAD
V1-V7
Inferior wall infarctions (RV infarction) is associated with what artery and which leads?
RCA
II, III, aVF, V3R-V6R
Lateral wall infarctions are associated with which artery and what leads?
Circumflex
I, aVL, V5-V6
Posterior wall infarctions are associated with which artery and which leads?
Posterior descending artery
V1-V3
What leads will you look at for a true posterior infarct and what will they show?
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)
What would you see in the following labs after an MI:
- WBCs:
- CRP:
- BNP:
Increased WBC (hrs to 2-4 days)
Increased CRP
BNP increased in ventricular wall stress and fluid overload
The majority of deaths related to AMI occur within 1 hr of onset of symptoms and most deaths are related to ___
V fib
What is the E.D. Standard of care for a STEMI?
12 lead ECH with continuous cardiac monitoring
IV lines inserted
Cardiac enzymes (cTnI), CBC, CMP, PT, PTT
What do you want to do for reperfusion strategy in STEMI?
Primary percutaneous coronary intervention (PCI) with angioplasty and stunting
Cath lab within 90 mins (goal)
When do you ideally want to begin fibrinolysis in STEMI in the ED?
Within 30 minutes
Primary PCI is preferred for STEMI with symptoms less than __ hours
12
Lower mortality rate and intracerebral hemorrhage
What is a major risk for for fibrinolytic therapy in a STEMI or new left BBB within 12 hrs of onset of symptoms?
Intracerebral hemorrhage
What can you give for initial medical management for a STEMI?
Aspirin - given on presentation unless contraindicated
This drug can relieve vasoconstriction; relieve pain (chest), reduce pre and afterload
Nitroglycerin
When do you not want to give a B blocker for a pt with a STEMI?
Dont use in decompensated HF, decreased HR, decreased BP
What can you give to a pt who has acute pericarditis after an MI?
Aspirin
NSAID
What sort of rhythm disturbances can occur following an MI?
V fib (Rx elective cardioversion)
Catch
Polymorphic V tach
V flutter
This benign arrhythmia can occur following fibrinolytic therapy:
Accelerated idioventricular rhythm (AIVR)
Sinus bradycardia is associated with an __ MI (up to 40% pts)
Inferior
Second degree AV block Wenckebach is associated with __ MI
Inferior wall
____ is the leading cause of hospital death from AMI
Heart failure
Acute mitral valve regurgitation can occur following an MI as a complication d/t
Rupture or dysfunction of papillary muscle
A new holosystolic murmur is a mechanical complication following an MI associated with a ___ MI
Inferior wall
Need surgery
Septal rupture with Ventricular septal defect is associated with an __ MI
Anterior wall
LV free wall rupture can cause __
Tamponade
LV aneurysm is associated with an __ MI
Anterior
Most MIs are caused by this underlying condition:
Atherosclerosis
