MI 18 Questions Flashcards
HR*SV
CO
CO*BMI
CI
Length of Cardiac Fiber & amy of bld in ventricle during diastole –> Force of contraction
Starlings Law
Normal Ejection Fracture
60-70%
Leading cause of morbidity and mortality
MI
Transmural Necrosis
4-6h
Subendocardial Necrosis
w/in minutes
Q wave
Zone of infarction
ST Elevation
Injury
T wave inversion
Ischemia
Location of Infarct determined by
EKG
Leads V1-V4
Anterior (LAD)
Leads II, III, aVf
Inferior (RCA)
Leads V5-V6, I, aVl
Lateral, Circumflex
Healing process post MI begins
in 24h
Post MI tissue is vulnerable
10-14d
Most Indicative Lab
Dx Acute MI
Troponin (protein)
Determine extent and tx of MI
Serial EKG
ST-elevation (1mm+/-)–> (Fireman’s hat)
Appear w/in few hrs
ST elevation returns to normal post MI
~2weeks
Normal Q
<1mm
Q wave changes (post MI) appear..
hours to days after MI..
Does not return to norm.
Primary goal of Tx (MI) acute phase
RELIEVE PAIN***
then control arrhythmias & stop progression
Greatest S/S of Ischemia
pain
Most common SE of MI
arrhythmias–> constant monitoring
First line anti arrhythmic
Amiodarone
Decrease REMODELING of ventricle, ventricular dilation, CHF & mortality
ACE Inhibs
Increase in Temp post MI
Indicates myocardial necrosis process
PTCA w/in
90mins of MI
ONLY FOR WITNESSED V-FIB ARREST W/ ROSC
Therapeutic Hypothermia
–>improved neurological o/c
Hypothermia Protocol Temp
32-34C for 18-24h
Monitored w/ bladder probe
Ice packs and cooling blankets
Cause sudden death 2h post AMI
V. Fib
Sinus Brady post AMI
40% inferior wall
No Tx unless S/S
Most common reperfusion rhythm
tolerated well
no Tx
Accelerated Idioventricular Rhythm
hypersensitivity to necrotic products
Pericarditis w/ pleural effusions
10d-3mo Post MI
Dressler’s Syndrome
Pleuritic pain w/ breathing
Friction Rub
Left Pleural Effusion
Fever
Dressler’s Syndrome
Ventricular Septal Rupture
Medical Emergency
Blood shunted from LV–>RV
New, Loud systolic murmur
Progressive dyspnea
Tachycardia
Pulmonary Congestion
Ventricular Septal Rupture
Cardiac cath/ Sx in OR–>patch
Nipride (afterload reducers)
Lasix (decrease preload)
5-6d post MI
Sudden neck vein distention
Decreased BP (hypotention)
PEA
Cardiac Rupture
Rapid, Typically death
1st line antiarrhythmic
Amiodarone
For PVC’s & Vtach give
Lidocaine
decrease infarct sz, pre/after load, HR/ contractility
BB
decrease remodeling of ventricle
ACE
SE: Cough
Therapeutic Hypothermia only for
witnessed V-fob arrest with ROSC
Tx PVC
IV Lido, Pronestyl, Cordarone
Most common re-perfusion rhythm
Accelerated Idioventricular Rhythm (No Tx)
Common cause of Acute Pulmonary Edema
Left Sided HF
Paroxysmal Nocturnal Dyspnea
Coughing w/ frothy blood tinged sputum
Acute Pulmonary Edema
Digoxin
Positive Inotropic Agent
Cardiac glycoside
Dobutamine (Dobutrex)
B-adrenergc agonists
+ Inotropic Agent
SE of Dobutamine
Increased Ventricular Irritability
Increased O2 demand by myocardium
Dobutamine –>
increased contractility and renal, mesenteric, coronary, & cerebral blood flow
Venous Arterial Smooth Muscle Vasodilator
Nipride
Cyanide Toxicity N/V Confusion Tinnitus Hypotension
Nipride
Biventricular Pacing
Resynchronization
only when asynchronous btwn ventricles
loss of 40% fund myocardium –>
Cardiogenic Shock
Dopamine
Vasopressor
Increases Contractility, CO, BP
Use central line-vessicant
SE Dopamine
HA, Palpitations, Tachycardia
Tissue Sloughing
Dobutamine Decreases
PAP & PVR
Dobutamine Increases
CO, SV
(minimal HR & BP)
Preferred when no hypotension
Inocor decreases
preload and afterload
relaxes vascular smooth muscle
3 purposes of Intra-Aortic Ballon Pump
Relieves the LV workload
Forces blood into Coronary arteries
Decreases Afterload