Clinical: 8 Acute MI Flashcards
Describe what Reperfusion Treatment Therapy is
- Tx within 3 hours = 50% reduction in mortality
- Can treat up to 12 hours after onset
- Limit infarct size and preserve LV function
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Relate Fibrinolysis and MI Treatment
- Administer in less than 30 minutes
- tPA, TNK, rPA
- Administer along with ASA and/or P2Y12 Inhibitor and Heparin
- Only effective in case of a STEMI
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What are the Indications for thrombolytic therapy?
- STEMI onset within 12 hours
- Most effective in 90 minutes
- ST elevation of at least 1 mm in 2 contiguous leads
- 2 mm in leads V2 and V3 for men, 1.5 for women
- New LBBB
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What are the Fibrinolysis Contraindications and major risk?
- Intracranial hemorrhage in approximately 1% of patients treated with fibrinolytics for MI
- Higher risk in patient’s over 75 yo
- Use PCI instead
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Describe PCI: post op care
Dual antiplatelet therapy for 12 months, ASA and P2Y12 inhibitor
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When do you use PCI or Fibrinolytics?
When PCI cannot be done in 120 minutes use FIBRINOLYTICS
Any contraindications for fibrinolytics or cardiogenic shock use PCI
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Describe an MI Complication AV Block
- RCA supplies blood flow to the SA and AV nodes
- Block may be transient and related to vagal tone
- May respond to atropine since it is at the AV level
Describe MI Complications of LBBB
- Damage to conducting system
- Presents with new LBBB
- Clinical symptoms of MI and new LBBB treat as MI
Describe the uses of Cardiac US and Echocardiography
View for regional or global wall abnormalities
Ischemic muscle - wall motion abnormalities
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Describe the how Pericarditis relates to MI
- Pain decreases with sitting up
- Dressler Syndrome - post MI syndrome
- Pericardial and pleural effusions
- May be inflammatory or immune related with fever and malaise
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Describe a Right Ventricular Infarct
- RCA 85%, LCX 15%
- Fluid back up in systemic circulation
- Distended neck veins
- Hypotensive
- Right sided EKG, elevation RV4
- IV fluid bolus without NITRATES (AVOID)
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What are the pitfalls of ECG?
Diagnostic in 50% of AMI cases
Entirely normal in 20% of AMI cases
What are the Q Wave ECG Findings?
- consistent with previous MI
- Transmural ischemia
- 1mm wide
- 1/3 amplitude of R wave
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What is the treatment for Post-MI Infarction?
- Lifelong aspirin and/or P2Y12 inhibitor
- Stent placed - aspirin and P2Y12 inhibitor for a year
- Beta-blocker within first 24 hours unless contraindicated
- Lifelong high intensity statin
- Cardiac rehab program
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