Mechanical Complications of Acute MI

Question 1

Situation Which Leads to Myocardial Rupture

Answer 1

nonperfused STEMI, 3-5 days later

Question 2

Treatments for Chronic CAD (3/4)

Answer 2

Aspirin, BBs, statins

Maybe ACEi, depending on other organ involvement and EF

Question 3

2 Drugs Helpful to Prevent Post-MI Remodeling Problems

Answer 3

ACEis and BBs

Question 4

True vs. False Aneurysm

Answer 4

True: Weakening of all 3 layers getting outpouching/stasis/clots. Usually result of infarction
False: Punch a hole in wall, narrow neck w/ hematoma contained by outer layer of vessel heart. Can rupture and bleed out

Question 5

Cardiac Thrombus Treatment

Answer 5

Coumadin/aggressive anti-coag

Question 6

2.3 Mechanical Complications of STEMI (& timeframe)

Answer 6

RV MI -> acute HF (3 days) - Free wall, VSD, and papillary muscle

Question 7

RV Infarction Cause

Answer 7

Occlusion of dominant R coronary a.

Question 8

4 Clinical Findings of RV MI

Answer 8

Hypotension
JVD
Kussmaul’s Sign
Clear lungs

Question 9

2 Conditions w/ Kussmaul’s & how to Differentiate

Answer 9

RVMI and Constrictive Pericarditis. Former is acute and latter is chronic

Question 10

RV MI dx

Answer 10

V4R > 1mm ST elevation (early)

Question 11

Treatment for RV MI (2)

Answer 11

Volume Loading w/ IV Saline, maybe ionotropic dobutamine if don’t respond

Question 12

Only Way You Don’t Die Immediately w/ Free Wall Rupture

Answer 12

False aneurysm. But pretty much you die every fuckin time from tamponade

Question 13

Distinguish VSD from MR (both w/ holosystolic murmurs)

Answer 13

VSD has thrill bc blood rushing to RV

Question 14

Anterior Wall vs. Inferior Wall Rupture

Answer 14

Ant usually VSD

Inf usually papillary muscle

Question 15

O2 Step-Up

Answer 15

O2 saturation in RV increases about 5-7% from 75% bc get blood from LV mixing

Question 16

Papillary Muscle Rupture

Answer 16

Basically like crazy prolapse w/ flailing muscle and shit. Huge v wave for filling and no O2 step up