davidson MI

Question 1

MI signs

Answer 1

drome is wide and includes
most causes of central chest pain or collapse. Chest pain at rest is the cardinal symptom but breathlessness, vomiting and collapse are also common features (Box 16.49). The pain occurs in the same sites as angina but
is usually more severe and lasts longer; it is often described as a tightness,
heaviness or constriction in the chest
breathlessness, nausea

Question 2

Vfib treat in 48 h correct hypokalemia

Answer 2

Afib untreated but if pt develops hypotension or HD instability(atropine, digoxin,beta blocker). Anticoagulation

Question 3

Patients with dynamic ECG changes and ongoing pain should
be treated with intravenous glycoprotein IIb/IIIa receptor antagonists
Recurrent angina, check for coronary angiogram

Answer 3

second and third days. dont use NSAIDS in pericarditis, use opiate based analgesics

Question 4

Papillary muscle rupture

Answer 4

This typically presents with acute pulmonary oedema and shock due
to the sudden onset of severe mitral regurgitation. Examination usually
reveals a pansystolic murmur and third heart sound but the murmur may
be quiet or absent in patients with severe regurgitation

Question 5

DRESSLER SYNDROME

Answer 5

This syndrome is characterised by persistent fever, pericarditis and pleurisy, and is probably due to autoimmunity. The symptoms tend to occur a
few weeks or even months after MI and often subside after a few days. If
the symptoms are prolonged or severe, treatment with high-dose aspirin,
NSAIDs or even glucocorticoid steroids may be required.

Question 6

VSD

Answer 6

sually presents with sudden haemodynamic deterioration
accompanied by a new loud pansystolic murmur radiating to the
right sternal border, which maybe difficult to distinguish bw MR
Rt heart failure

Question 7

VSD

Answer 7

sually presents with sudden haemodynamic deterioration
accompanied by a new loud pansystolic murmur radiating to the
right sternal border, which maybe difficult to distinguish bw MR
Rt heart failure

Question 8

Rupture of the ventricle may lead to cardiac tamponade and is usually
fatal,prophylactic anticoagulants for THROMBOEMBOLISM

Answer 8

As the ventricle dilates, it
becomes less efcient and heart failure may supervene. Infarct expansion occurs over a few days and weeks but ventricular remodelling can
take years. Beta-blocker, ACE inhibitor and mineralocorticoid receptor
antagonist therapies can reduce late ventricular remodelling and prevent
the onset of heart failure.

Question 9

VENTRICULAR ANEURYSM

Answer 9

. Heart failure, ventricular arrhythmias, mural thrombus and systemic embolism are all recognised complications of aneurysm formation. Other features include a paradoxical impulse on the chest
wall, persistent ST elevation on the ECG, and sometimes an unusual
bulge from the cardiac silhouette on the chest X-ray. Echocardiography
is diagnostic

Question 10

The initial ECG may be normal or
non-diagnostic in one-third of cases.. Repeat them, earliest change is ST segment deviation

Answer 10

ST segmant Elevation, diminished R wave, T wave inverted

Question 11

NSTEMI ECG change
non-ST segment elevation acute coronary syndrome, there is partial
occlusion of a major vessel or complete occlusion of a minor vessel,
causing unstable angina or partial-thickness (subendocardial) MI

Answer 11

n . This is
usually associated with ST-segment depression and T-wave changes. In
the presence of infarction, this may be accompanied by some loss of R
waves in the absence of Q waves (

Question 12

CXR shows edema or cardiomegaly( prev damage to heart)

Answer 12

ENZYMESCreatine kinase (CK) and troponins T (Tn-T) and I (Tn-I)
are the rst to rise, followed by aspartate aminotransferase (AST) and then lactate
(hydroxybutyrate) dehydrogenase (LDH). In patients treated with reperfusion therapy, a
rapid rise in plasma creatine kinase (curve CK(R)) occurs