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Cardiovascular > MI > Flashcards

MI Flashcards

1
Q

two most important factors of an MI

A

location and time

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2
Q

average age of first time cardiac event in F and M

A

F 72
M 62

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3
Q

greatest potential for decreasing morbidity and mortality is by

A

decreasing the amount of time from injury to presentation

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4
Q

majority of MIs result from

A

occlusive coronary thrombus at the site of a pre-existing atherosclerotic plaque
cocaine
hypoperfusion

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5
Q

explain how a thrombus causes an MI

A
  1. acute event caused by sudden atherosclerotic plaque rupture
  2. raw surface of ruptured plaque stimulates formation of blood clot or thrombus
  3. thrombus leads to further narrowing of the artery
  4. narrowing and blockage slows or even stops flow of blood to myocardium
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6
Q

explain how cocaine causes MI

A

vasospasms, platelet activation, and increased myocardium O2 demand

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7
Q

MI classical presentation

A

pain described as viselike or an elephant sitting on chest
onset with minimal exertion or at rest
radiates to jaw, neck, arms, back, and epigastrium
most often in the morning
pain builds quicker lasts longer and is more sever than angina
NTG has little to no effect

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8
Q

variations from classic presentation

A

older pts, women, and pts with DM
elderly and DM sx include fatigue weakness syncope
some are silent
women most likely to have jaw, neck, throat, arm/shoulder pain

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9
Q

associated manifestations

A

sense of impending doom
nausea/abd pain
anxiety
diaphoretic
cough
cold speat
wheezing
syncope

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10
Q

PE findings

A

diaphoretic and pale
HR: bradycardia for inferior infarct; tachycardia
BP: hypotension for ventricular dysfunction dt ischemia
Acute valvular dysfunction: mitral regurgitation dt papillary muscle MI

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11
Q

dx studies

A

Cardiac specific markers
CXR
EKG
Echo
Labs

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12
Q

cardiac specific markers

A

Troponin T and I
Creatine-Kinase MB
Myoglobin

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13
Q

which cardiac marker offers greatest specificity

A

Troponin I

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14
Q

why is troponin I preferred over creatine-kinase MB to dx MI

A

specificity and sensitivity are not as high

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15
Q

how long do cardiac markers take to become positive

A

4-6 hours post onset of MI

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16
Q

if a pt comes in with MI sx but troponin is normal what could this indicate

A

treat the patient not the sx

17
Q

why is myoglobin not a great cardiac marker

A

is also released from skeletal muscle atrophy

18
Q

why is troponin I preferred over troponin T

A

troponin T may elevate in muscle injury or renal failure

19
Q

EKG of acute MI shows

A

ST segment elevation

20
Q

EKG of old MI shows

A

pathological Q wave (1/3 size QRS complex)

21
Q

what can CXR r/o

A

aortic knob tear (presents similar to MI)

22
Q

what does an echo show

A

ejection fraction and evidence of dysfunctional valves

23
Q

what cardiac imaging best shows the extent of MI

A

MRI with gadolinium contrast enhancement

24
Q

what labs should be ordered

A

CBC with diff- anemia and platelets
CMP- BUN Creatinine, AST/ALT, electrolytes (K+ Mg2+)
PT/PTT/INR
Lipid Panel
C-reactive protein
Cocaine toxicology screen

25
Q

initial management of MI

A

ASA, Nitrates, Analgesia

26
Q

ASA tx

A

162-325 mg immediately
clopidrogel and prasugrel
ASA allergy–P2Y12 inhibitor (clopidrogel, prasugral, or ticagrelor)

27
Q

nitrates tx

A

0.4 mg sublingually q 5 mins PRN chest discomfort
lowers BP and pulmonary congestion

28
Q

analgesia tx

A

morphine sulfate 2-4 mg IV push q 15 minutes PRN pain
meperidine 50-75 mg q 15 minute PRN pain

29
Q

in the presence of chest discomfort think

A

IV-O2-Monitor
IV- easier when pt is awake
O2- 6L nasal canula (not for COPD)
Monitor- get EKG and put pt on monitor

30
Q

MONA therapy

A

morphine
oxygen
nitrates
asa
-also LMW heparin/heparin

31
Q

therapies

A

beta blocker, ace inhibitors, reperfusion tx

32
Q

beta blocker tx

A

reduces infarct size and early mortality
decreased O2 demand dt reduced HR, contractility, BP, and relief of ischemic pain
decreased risk of Vfib
propranolol, metoprolol, atenolol

33
Q

ACE inhibitor tx

A

increases EF
only recommended in pts w/o HTN
reasonable for all pts following a STEMI w/o contraindications

34
Q

types of reperfusion

A

mechanical and pharmacological

35
Q

Mechanical reperfusion tx

A

percutaneous transluminal coronary angioplasty
door to balloon time needs to be <90 mins
superior to fibrinolysis but not widely available

36
Q

pharmacological reperfusion tx

A

thrombolytic tx
dissolves the clot, improves blood flow, prevents damage to organs
golden hour if within the first hour and 6 hours is the cutoff
complications: hemorrhage or intercranial hemorrhage

Cardiovascular (10 decks)

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