MI Flashcards
why does a cardiac arrest occur after MI?
ventricular fibrillation
why would a person develop cardiogenic shock after an MI?
if the infarction affects a large part of the ventricular myocardium that the ejection fraction decreases.
patients may require ionotropic support and or intra aortic balloon pump
what can help in chronic heart failure?
loop diuretic furosemide will decrease fluid overload. ACE i and beta blockers improve long term prognosis
what is more common following an inferior MI?
atrioventricular block
besides ventricular fibrillation what other arrhythmias occur following an MI?
ventricular tachycardia
in the first 48 hours after a transmural MI what can occur?
pericarditis (pain worse on lying flat)
dresslers syndrome pathophysiology?
autoimmune reaction against antigenic proteins formed as myocardium recovers.
what is dresslers syndrome characterised by?
fever, pleuritic pain, pericardial effusion and a raised ESR. treated with NSAIDs
how does a left ventricular aneurysm develop?
ischaemic damage weakens the myocardium resulting in aneurysm formation- persistent TS elevation and left ventricular failure
why does left ventricular free wall rupture?
3% MI, 1-2 weeks after. Acute heart failure due to tamponade (raised JVP, pulsus paradoxus diminished heart sounds)
how to treat left ventricular free wall rupture?
urgent pericardiocentesis and thoracotomy
ventricular septal defect?
1-2% after 1 week.
pan systolic murmur acute heart failure
echo is diagnostic to exclude mitral regurgitation
urgent surgical correction
why do you get acute mitral regurgitation?
infero-posterior infarction due to ischaemia or rupture of papillary muscles,
acute hypotension pulmonary oedmea
early to mid systolic murmur
patients are treated with vasodilator therapy but require emergency surgical repair
when should sex resume after MI and what drugs can you take after 6 months?
4 weeks
PDE5 inhibitors sildenafil
PDE5 inhibitors are contraindicated with?
nitrates or nicorandil
Post MI treatment prevention
post acute coronary syndrome (medically managed): add ticagrelor to aspirin, stop ticagrelor after 12 months
post percutaneous coronary intervention: add prasugrel or ticagrelor to aspirin, stop the second antiplatelet after 12 months
patients with acute MI and signs of heart failure should?
eplerenone within 3-14 days of MI
for thrombolysis what has clearer mortality benefits over streptokinase?
tissue plasminogen activator tPA
after thrombolysis when should ECG be performed?
90 minutes, resolution greater than 50% in ST elevation
how to treat hyperglycaemia in ACS
a dose-adjusted insulin infusion with regular monitoring of blood glucose levels to glucose below 11.0 mmol/l
