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Cardiology 2 > MI Complications > Flashcards

MI Complications Flashcards

1
Q

When are arrythmias most likely to occur?

A

During acute Myocardial ischemia/Infarct

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2
Q

What is a PVC?

A

Premature Ventricular Contraction

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3
Q

What is Accelerated Idioventricular Rhythm?

A

Ventricle takes over pacemaker activity of the heart. Caused by enhanced automaticity of the Purkinjie fibers.

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4
Q

What is Ventricular Tachycardia?

A 
Induced by ischemia
QTc may or may not be prolonged
Usually Polymorphic
VT from a scar is usually Monomorphic
Needs immediate Cardioversion
Tx with Amiodarone or Lidocaine
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5
Q

What is V Fib?

A 
Late VT/VF > 48 hrs after MI asociated with increased risk of sudden cardiac death following discharge
Tx: Defibrillation
AMiodarone
BB, correct Elytes
R/O Recurrent ischemia, reinfarct
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6
Q

What is prophylaxis for sudden cardiac death?

A

Late VT/VF >48 hrs after MI

EF

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7
Q

What is PCI?

A

Per-Cutaneous intervention

Putting a stent in to open up a clogged artery

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8
Q

What is the Blood Supply to the Sinus node?

A

55% RCA
35% LCX
10% dual supply

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9
Q

When are you most likely to see Sinus Bradycardia?

A

Acute MI from blocked vessel to Sinus Node

RCA, LCX or dual

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10
Q

What is An AV block from an Inferior MI?

A 
Block at AV node level
From: high PS tone
Local Accumulation of K
AV node Ischemia
Usually Transient
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11
Q

What is An AV block from an Anterior MI?

A

Rare
Usually Below AV node level
Implies Extensive infarct with BB inv.
Usually permanent- Needs pacemaker

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12
Q

What is Heart Failure?

A

secondary to Diastolic Dysfunction(or syst/diast)

Lungs fill up with fluid because of back-up of fluid

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13
Q

What is the Tx for Heart failure during Acture MI?

A

Vasodilators esp IV nitro
Diuretic if fluid overloaded
Morphine if angina or anxiety (avoid HypoTN, resp distress, high doses)
BiPap, intubation if resp compromise.

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14
Q

What is the Tx for Heart failure during Post Acute phase?

A 
Diuretic 
ACE- Inhibitors 
Aldosterone Antagonists 
-Spironolactone or epleronone
Wait on BB til compensated
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15
Q

What is a Cardioembolism?

A 
Associated with large Anterior Wall MI
Risk inc when Reduced EF
Apical Wall motion abnormality 
LV aneurism devt
Echo can help Diagnose
Tx is anticoagulation with warfarin
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16
Q

What is early Pericarditis?

A 
In transmural infarct
From local inflammation of pericardium overlying infarcted myocardium
Pleuritic chest pain
Friction rub
ECG changes can be masked
17
Q

What is Tx of Early Pericarditis vs Late?

A

Early: aspirin 650 mg
Colchocine(Anti Inf)
Avoid NSAIDS, steroids(Impair Healing)

Late: Dressler’s Syndrome
AI mechanism
Pericarditis + systemic symptoms
Tx- ASA, Colchocine

18
Q

What are the mechanical complications of MI?

A

Free wall rupture
VSD
Papillary Muscle Rupture

19
Q

What are the risk factors for MI related VSD?

A 
AWMI or IWMI
Older Pt
Females 
H/O HTN
First MI
Delayed or absent Reperfusion

Thrombolytics reduce infarct size but promote Hemmorhagic dissection of myocardium

20
Q

What is the presentation of MI related VSD?

A

Chest Pain, Dyspnia, Hypotension, Biventriculr Failure
Harsh, Holosystolic Murmur LLSB
Thrill in 50% of Pts
S3, Loud P2

21
Q

What is an oxygen “Step up?” How does it help you diagnose MI related VSD?

A

Oxygenated blood from LV comes over to RV and Oxygen readings increase from 66% to 86%. >5% increase is indicative

22
Q

What is MI related Acute Mitral Regurgitation?

A

Papillary Muscle Dysfunction
Rumpture of chordae Tendinae
Caused by an inferior MI
Most commonly in the POSTEROMEDIAL PAPILLARY MUSCLE

23
Q

What is the presentation of MI related Acute Mitral Regurgitation?

A

Similar to CHF
New systolic murmur (not always loud)
Intensity doesn’t predict severity
“V” Waves

24
Q

What is the Tx of MI related Acute Mitral Regurgitation?

A

Mechanical Ventilation

Afterload Reduction by IABP (intra aortic baloon pump)

25
Q

How can you differentiate VSD from Acute MR?

A

Thrill present in Half of VSD Pts

Rare in acute MR

26
Q

What is an MI related Free wall rupture?

A

Tear or dissecting Hematoma

More common with fibrinolysis compared to PCI

27
Q

What is the Presentation of MI related Free wall rupture?

A 
Acute: Sudden Hemodynamic Collapse, Cardiac Tamponade, PEA arrest
Transient Bradycardia preceding rupture
Restless, nauseated, anxious
Subacute: Represents a contained rupture
Pericardial Pain, Hypotension
28
Q

How is MI related Free wall rupture diagnosed?

A

Echo-Pericardial Effusion, Features of tamponade

PA Catheter- Shows tamponade physiology

  • Eq of diastolic Pressures
  • Blunted y-descent on RA tracing
29
Q

What is the Tx for Free wall rupture

A

Emergency Surgical Repair

Pericardiocentesis can be temporary fix

30
Q

What is Cardiogenic Shock?

A

Inadequate oxygen and nutrient delivery to the cells

31
Q

What is an intraortic Baloon pump?

A

Augments coronary blood flow during diastole
Decreses Afterload
Reduces myocardial Ischemia

Cardiology 2 (16 decks)

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