MI diagnostic studies and Treatment

Question 1

What characterizes ST elevation?

Answer 1

Definition: > 0.1 mv

Question 2

Inferior MI characterizations

Answer 2

On ECG elevations in II, III and aVF

Question 3

Posterior MI characterizations

Answer 3

On ECG elevations in leads V1 and V2

Question 4

Anteroseptal MI characterizations

Answer 4

On ECG Leads V1 and V2

Question 5

Anterior MI characterizations

Answer 5

On ECG V1, V2 and V3

Question 6

Anteriolateral MI characterizations

Answer 6

On ECG V4, V5, V6

Question 7

Describe ECG progression of ST elevation MI

Answer 7

peaked T waves to ST segment elevation to Q waves to T wave inversion

Question 8

Describe CXR progression of CHF

Answer 8

1. Stage 1 CHF-

• redistribution of pulmonary vessles (13-18 mm Hg)
• Cardiomegaly
• Broad vascular pedicle

2. Stage 2

• Interstitial edema (18-25 mm Hg)
  
  • Kerley B lines
  • Peribronchial cuffing
  • Hazy contour of vessles
  • Thickened interlobular fissure

3. Stage 3

• Alveolar edema (> 25 mmHg)
• Consolidation
• Air bronchogram
• Cottonwool appearance
• Pleural effusion

Question 9

Cardiac Echo

Answer 9

Transthoracic vs Tranesophageal echo

Question 10

Pre-Hospital treatment of MI

* 50% of deaths from MI occur before the pt reaches the hospital

Answer 10

1. Aspirin 81 mg x 2= 162 mg or 325 mg immediately
2. Clopidogrel (Plavix) 300 mg given once as loading dose
   * Titrate down to clopidogrel 75 mg/day
3. Vasodilator- to help relieve ischemic pain
   * Nitroglycerin
4. Morphine for pain control if Nitro not effective
5. Enoxaparin (better than heparin) significant reduction in death and MI at day 30

Question 11

Thrombolytic therapy for MI

Answer 11

1. Most effective in 1st 3 hours. (50% reduction in mortality)
   * Pts should be treated up until 12 hours after onset of symptoms (10% reduction in mortality)
2. • ST elevation- suggests ascute coronary occlusion- warranting reperfusion
3. Streptokinase no longer avail in US
4. Tissue plasminogen activator (t-PA)

Question 12

What are contrinidations to using tissue plasminogen activator t-PA?

Answer 12

1. Stroke within one year
2. Intercranial neoplasm
3. Recent Head trauma
4. Active internal bleeding
5. Concern for aortic dissection

Question 13

What are relative contraindications for tissue plasminogen activator t-PA?

Answer 13

1. Blood ressure > 180/110
2. IntrAcerebral pathology
3. Trauma within 2 weeks
4. Major surgery in the past 3 weeks
5. CPR lasting more than 10 minutes
6. Pregnancy
7. Current use of anti-coagulants

Question 14

When do you performe PCI percutaneous coronary intervention?

Answer 14

Catherization and stenting has been shown to be better than thrombolytic therapy when performed by experienced people and in a high volume center

1. Door to balloon time < 90 min

Question 15

If PCI is not a viable option may have to progress to this procedure for MI

Answer 15

CABG Coronary artery bypass grafting

Question 16

Septal wall MI characterizations

Answer 16

Abnormal Q waves in leads V1 and V2

Question 17

Anterior wall MI Characterizations

Answer 17

Q waves in V3 and V4

Source:

https://doi.org/10.1161/CIRCULATIONAHA.106.624924

PMID: 17043179

Question 18

Lateral wall MI characterizations

Answer 18

Q waves in V5, V6, I, and aVL