MI Flashcards
Cardinal sign of CV disease?
Chest pain, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, coughing, wheezing, fatigue, weakness, and pain in extremities with exertion.
Talk about what we see on EGK with STEMI, what feature of a stemi indicates its severity, and what is most commonly the MAO?
Elevated ST. It is a transmural infarction, so the whole wall of heart. Complete interruption of blood flow due to a coronary occluded by a thrombus.
Most common cause of MI?
Atherosclerosis. Erosion, fissuring or rupturing of the plaque.
What patient population can have “silent” or painless MIs?
Diabetics and elderly ladies.
What are a few things that can be present during physical exam of an MI patient?
Normal. s4 gallop. Increase or decrease in autonomic activity.
What type of MI is associated with increased sympathetic and what type is associated with increased parasympathetic?
anterior MI increased sympathetics, inferior MI increased parasympathetics
What is the EKG criteria for a tracing to be considered STEMI for a male?
ST elevation 2 mm of greater at J point in V2 and V3
EKG criteria for STEMi in a female?
ST elevation of 1.5mm of greater at J point in V2-V3
What is the alternate criteria for male or female with STEMI?
1mm of greater ST elevation in 2 or more contiguous chest or limb leads.
EKG changes for NSTEMI and NSTE ACS? What is the main difference between the two?
ST segment depression and T wave inversion.
Cardiac enzymes are elevated in NSTEMI and normal in NSTE ACS
What are three other main causes of ST elevation?
Pericarditis, LVH, and normal variant repolarization.
What two MI’s take two weeks for the ST elevation to resolve?
Inferior and lateral anterior wall.
What am I thinking if the ST elevation is continuing past 2 weeks?
Ventricular aneurysm
What can normal displacement of ST segment be?
It can normally be elevated up to 1mm in standard leads and up to 2mm in chest leads. But it is never normal depressed more than 1/2mm
ST depression and ST elevation is indicative of what kind of damage to the heart?
ST depression is subendocardial and ST elevation is sub pericardial or transmural injury or ischemia
Normal height of t wave in standard and precordial leads?
Not greater than 5 mm in standard and 10 mm in precordial
What is the marker on EKG for infarction and why does it occur?
Q wave due to lack of depolarization
What is the marker on EKG for injury?
ST elevation
What is the marker for ischemia?
T wave changes
What 3 land values will be increased with MI that are separate from the cardiac markers?
WBC, CRP, and BNP
2 cardiac markers for MI, when do they become detectable in the blood after MI, peak hours of the markers in the blood, how long do they persist, and what can cause a false positive of them?
Cardiac troponin T and I. 1-4 hours they become detectable. 10-24 they peak. Persist for 5-14 days. Renal failure.
What are three conditions that are pulmonary causes of elevating troponin levels?
PE, Pulmonary HTN, and Respiratory failure
2 neuro causes of troponin elevation?
Stroke and intracranial hemorrhage
2 other important causes of conditions that elevate troponin?
Shock and renal failure.
What is the standard of care for a STEMI in the ED, 3 things?
- 12 lead EKG with continuous monitoring.
- IV lines inserted
- Labs: Cardiac enzymes, CBC, CMP, PT, and PTT
How quickly is the goal to get the individual in the cath lab and to have fibrinolytic?
90 minutes for cath lab and 30 minutes for
What suggests failure of fibrinolytics in providing reperfusion?
Failure of ST elevation to resolve by 50%
If hospital does not have a cath lab, what is the goal to get them transferred?
Within 120 minutes
Primary PCI or cath lab is preferred for what type of MI patients?
Preferred for STEMI with symptoms less than 12 hours
Fibrinolytic therapy is useful when specifically?
STEMI or new left BBB within 12 hours of the onset of symptoms
Upon a patient presenting with a STEMI, what are they given unless contraindicated?
ASA by mouth
After a person gets a stent, what do we want to give for a year and why?
ADP receptor blocker or some antiplatelet agent to prevent stent stenosis
What 5 meds might we also give an STEMI MI patient and why?
Nitro for pain and VC. Morphine for pain. Beta blockers to drop heart work. O2 ACEI to help bring BP up if EF sucks.
