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cardiology 2 > Myocardial Infarction > Flashcards

Myocardial Infarction Flashcards

1
Q

What is seen on ECG with a Non-STEMI or Unstable Angina?

A

Inverted T wave and ST depression

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2
Q

What is seen on ECG in a STEMI?

A

ST elevation

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3
Q

What is a Type 1 MI?

A

Spontaneous MI caused by a primary coronary event (plaque erosion or rupture)

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4
Q

What is a Type 2 MI?

A

MI secondary to Increased O2 demand or decreased supply

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5
Q

What is a Type 3 MI?

A

Sudden unexpected cardiac death. Cardiac arrest, ishcemia, ST segment elevation, or obstruction of a coronary

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6
Q

What is a Type 4a MI?

A

MI associated with PCI

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7
Q

What is a Type 4b MI?

A

MI associated with stent thrombosis

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8
Q

What is a Type 5 MI?

A

MI associated with CABG

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9
Q

What are the characteristics of an Unstable Plaque?

A 
Thin fibrous plaque
Inflammatory cells
Few SMC
Eroded endothelium
Activated macrophages
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10
Q

What are the characteristics of a Stable Plaque?

A 
Thick fibrous plaque
No Inflammatory cells
More SMC
Intact endothelium
Foam Cells
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11
Q

What is compensatory luminal expansion?

A

Lumen stays the same until severe CAD

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12
Q

What are the history features of an acute MI?

A

Chest Pain

Unstable angina

  • New onset
  • less activity
  • increasing frequency or severity
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13
Q

What are PE findings in an Acute MI?

A

GE: anxious, distressed, diaphoretic,

HR, BP, and Pulse ox can all be variable or normal!
Ocular Retinopathies of DM, HTN, gen Atherosclerosis

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14
Q

What are the Heart sounds associated with an acute MI?

A 
Paradox. Split S2 if LV dsfunction
S4 at the apex from stiff LV
S3 with LV dysfunction/HF
New systolic murmur
Pericardial Friction rub
Dec. PErfusion in extremities
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15
Q

Who presents atypically most often?

A

Elderly, women, diabetics

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16
Q

What are unusual causes of chest pain/MI in women?

A 
Spontaneous Coronary Artery dissection
Coronary Vasospasm(prinzmetal's angina)
Microvessel Disease(Cardiac syndrome X)
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17
Q

What are the causes of chest pain that can kill you?

A 
MI
PE
Pneumothorax
Acute Aortic Syndromes
-Dissection
-perforated ulcer
-intramural hematoma
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18
Q

What are the lab tests to do following an acute MI?

A

Serum Biomarkers:
Cardiac Specific Troponin
Creatine Kinase MB
Serum Myoglobin

Also evaluate for anemia, DM, dyslipidemia

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19
Q

What are the traits of Troponin in Acute MI?

A

Rise within 3 hrs of AMI
Released continuously
Peaks 24-48 hrs

20
Q

What are the traits of Creatine Kinase MB in Acute MI?

A

Exceeds normal in 4-8 hrs, back to normal in 2-3 days
peaks in 24 hrs
Also present in Skeletal muscle

21
Q

What are the different imaging modalities of Imaging in ACS?

A 
Chest XR
Echocardiography
Nuclear SPECT
CT Coronary Angiogrphy
Cardiac MRI
22
Q

What can tell you how extensive a STEMI/NSTEMI is?

A

The degree of ST elevation/depression and the number of leads involved

23
Q

When are delta waves seen?

A

WPW syndrome

24
Q

What are the immediate therapies for AMI?

A 
ECG within 10 min, 
ABCs, Vitals
IV Access
LABS
Stabilize the Patient
MONA
If consistent with STEMI Prep for Immediate Reperfusion
25
Q

What does MONA stand for?

A

Morphine, Oxygen, Nitro, Aspirin

26
Q

What are the 3 main Classes of medical therapy?

A

Antiplatelet Agents
Anticoagulant Agents
Anti-ischemic Agents

27
Q

What Antiplatelet agents are use in MI?

A

P2Y12 inhibitor

GP 2b3a inhibitor

28
Q

What Anticoagulant agents are use in MI?

A

.

29
Q

What Anti-ischemic agents are use in MI?

A

Beta Blockers(tachy and HTN or vent arrythmia)
IV Nitroglycerin(Acute pulm edema/CHF)
Useful if Pt is Hypertensive
Ca Channel Blockers

30
Q

What should all ischemic Chest pain patients recieve?

A

Oxygen low flow (keep above 90% O2 sat)
Aspirin
Sublingual NTG
Anticoagulant

31
Q

What are charicteristics of a STEMI?

A

Complete occlusion of Cor BF Myocardium is continually lost
ST elevation localizes the area of injury
Fibrin rich, red clot
Plaque is typically soft nd previously non-obstructive
-no collateral devt
-no ischemic preconditoning

32
Q

What are charicteristics of and Anterior Wall MI?

A

Bad prognosis because there is a lare amount of myocardium involved(LAD occlusion)
Widow Maker
AV block uncommon

33
Q

What are charicteristics of and Inferior Wall MI?

A

High vagal tone state
Low normal or Bradicardia from SA ischemia and Inc Vagal tone
AV block uncommon and usually transient

34
Q

What are the characteristics of Inferior wall MI with associated RV infarction?

A

JVD, Hypotension, Clear lung fields
Preload Sensitive, avoid NTG, caution with BB may need trial of IV fluids
Diagnose with V4R lead ECG

35
Q

How can a RV MI be better diagnosed?

A

Right sided EKG

36
Q

What are the gross changes following an Infarction?

A

6hr- Myocardium pale, bluish, edematous
18-36 hr- Muscle tan to purple with epicrdial exudate
8-10 days- Wall thins as necrotic tissue organized by fibroblasts
2-3 months- firm scar forms

37
Q

What is the management of a STEMI?

A

ASA
P2Y12 blocker
Beta Blocker(less ARR more cardiogenic shock)
Unfractionated heparin or bivalrudin if bleeding risk higher

38
Q

What are the benefits of using Fibrinolytic therapy?

A

Reduces mortality short and long term

Increased risk of stroke or major bleeding

39
Q

What are the contraindications for throobolytic therapy?

A

Past Intracranial Hemmhorrage

Cerebral vascular lesion…

40
Q

Who are the best candidates of PCI in STEMI

A 
Delayed presentation
High bleeding risk
Lytic contraindication or failed lytic
complex coronary  disease
Shock 
Compilication
diagnosis less certain
41
Q

What is a danger of PCI?

A

Can shower microthrombi downstream when Stent opened

42
Q

What is unique about a NSTEMI?

A

Platelet rich White clot
ECG changes do not localize the area of ischemia or culprit vessel
ECG may be normal (ST depression or T inversion)

43
Q

What are the guidelines for Tx for different patients?

A

VHRP?
HRP
IRP
LRP

44
Q

What are considerations for Post-MI care?

A

Assess Ejection fraction
Assess cardiovascular Risk factors
Education(event, meds, CV disease, heart healthy lifestyle)
Cardiac Rehab

45
Q

What drugs should be given in post MI care?

A

Aspirin 81-162 mg for life

P2Y12 inhibitor: Clopidogrel, ticagrelor for 1 year

46
Q

Why is readmission so high post MI?

A

Polypharmacy
Early discharge
Side effects
Feel overwhelmed and depressed

cardiology 2 (16 decks)

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