Myocardial Infarction

Question 1

what is the most common manifestation of coronary artery dz?

Answer 1

ACUTE MI

Question 2

PP of acute MI

Answer 2

spontaneous fissuring and rupture of a coronary artherosclerotic plaque-hight thrombogenic surface, platelet aggregation and fibrin formation

Question 3

what happens if the thrombus causes complete occulsion of the coronary artery?

Answer 3

STEMI

Question 4

what happens if STEMI is untx?

Answer 4

necrosis of myocardium, pathogen Q waves

Question 5

in NSTEMI, what is absent comparted to STEMI

Answer 5

Q waves

Question 6

unstable angina ?

Answer 6

transient thrombus and occulusion, but markers of infarction aren’t present

Question 7

stable angina pectoris

Answer 7

SOB, NV diaphoresis, deep pressure like pain, but only last 2-30 mins

**precipiated by physical exertion or emotional stress

**gets better w. rest or SL NTG

Question 8

what may you see on an EK G w/ stable angina?

Answer 8

LBBB, RBBB, fasicular blocks, non-specific ST-Twave changes

Question 9

ST segment changs w/o angina?

Answer 9

70% chance of sign CAD

Question 10

stress testing important thing to watch for

Answer 10

drop in SBP > 10 mmhg

Question 11

laboratory data for stable angina

Answer 11

*cardiac enzymes should BE NEGATIVE

CK, CKMB, troponin

Question 12

Acute Coronary Syndromes?

Answer 12

unstable angina to MI

Question 13

MI

Answer 13

results of prolonged M ischemia, usually as a result of thrombus formation on a presexisting atherosclerotic plaque

other causes include prolonged vasospasms, reduced myocardial blood flow, excessive metabolic demand, embolic occulstion, vasculitis, aortitis, coronary aretery dissections, cocaine use

Question 14

what do most ts die of during an MI

Answer 14

V FREAKIN FIB

Question 15

what population may present abnormally during an MI?

Answer 15

women, DM, and elderly

Question 16

what sx may elderly ppl have?

Answer 16

generalized weakness, stroke, syncope, or change in mental status

Question 17

unstable angina sx

Answer 17

new, sudden onset CP, pressure

• cP at rest or nocturnally,
• CP that used to be controled w. nitrates
• CP at greater frequeny

Question 18

Unstable angina diagnosits findings?

Answer 18

EKG similare to stable angina, but more likely tos how acute ischemic changes (ST depression and T inversion)

again, cardiac enzymes are negative

Question 19

tx of unstable angina

Answer 19

admit, monitor, bed rest/ox

**want to risk stratify w/ cardiac cath

Plavix (clopidogrel)

Question 20

NSTEMI CF

Answer 20

• New, sudden onset chest pain/pressure with associated SOB, nausea, diaphoresis.
• Chest pain at greater frequency, severity or with less activity.
• Chest pain at rest or nocturnally
• Chest pain previously controlled with nitrates, now refractory
• SAME AS UNSTABLE ANGINA! Difference: IN THE LABS + for cardiac biomarkers

Question 21

Wellen sign

Answer 21

deep inverted T waves in leads V1 through V4 are associated with severe disease in the left anterior descending artery

Question 22

DX NSTemi

Answer 22

cardiac enzymes are positive, more likely to show acute ischemic changes

ST segment depression

Question 23

TIMI risk score

Answer 23

• Age >65
• At least 3 risk factors for CAD
• Known coronary artery disease with at least 50% coronary stenosis
• ST segment changes
• At least 2 episodes of angina in the past 24 hours
• Aspirin use in the past week
• Elevated CK-MB troponin

Question 24

STEMI

Answer 24

caused by thrombotic obsturction of epicardial coronary arteries

Question 25

pe for a stemi

Answer 25

HTN, hypotension, tachy or brady, S3/S4, signes of CHF (pulmonary edema) friction rub -basilar rales or other findings of pulmonary edema

Question 26

what murmurs might you see on a pt w/ a stemi?

Answer 26

MR, VSD

Question 27

ST segment elevations w/in mins?

Answer 27

acute transmural ischemia

Question 28

inverted t waves and Q waves w/in hour may be a sign of what?

Answer 28

irreversible necrosis

Question 29

what happens to the T waves after a few weeks?

Answer 29

repolarzie and return upright

Question 30

changes in leads II, III, aVF

Answer 30

inferior *RCA, Left circumflex if left dominant

Question 31

leads V2-V5

Answer 31

anterior LAD

Question 32

leades I avL, V5-V6

Answer 32

lateral left circumflex

Question 33

leads II, III, AVF, I AVL

Answer 33

inferolateral Large RCA or left dominant left circumflex

Question 34

V4-V6, I AvL

Answer 34

anterlateral V4-V6, I , avL left circumflex

Question 35

Dressler Sydrome

Answer 35

post MI syndrome, includes pericarditis, fever, leukocytosis, pericardial or pleural effusion

Question 36

what sx may you see in a pt 12 and 24 hours after an MI?

Answer 36

low-grade fever after 12 hours friction rub after 24 hour

Question 37

what is the widow maker artery?

Answer 37

LAD

Question 38

what would a stemi look like on an EKG?

Answer 38

ST-segment elevations of >1 mm in two contiguous leads

Question 39

what is the normal progression of an EKG over hours to days in a STEMI?

Answer 39

peaked T waves to ST segment elevations to significant Q waves to T wave inversions

Question 40

what will NTEMI pts develop on the EKG?

Answer 40

non-Q wave MI, but some will show this

Question 41

what is suggested if someone presents with transient ST-segment changes of > .5 mm that develop during a syx episode and then resolve when the pt becomes asx?

Answer 41

acute ischmia or CAD

Question 42

what is a new LBBB on EKG suspicious for?

Answer 42

new MI

Question 43

what is the most specific cardiace biomarker for myocardial damage?

Answer 43

troponin T and or troponin I

Question 44

what is an important biomarker if a reinfarction is suspected?

Answer 44

CK-MB

Question 45

when is it important to measure the myoglobine levels?

Answer 45

if pt presents less than 6 hours after sx onset

Question 46

when should the troponin levels be measures?

Answer 46

8-12 hours after ACS and during initial sx

Question 47

what would an Echo show?

Answer 47

abnormalities of the cardiac wall motion or MR

Question 48

what would a CXR show?

Answer 48

indicate pulmonary vascular congestion or signs of aortic dissection

Question 49

when would you do a stress test?

Answer 49

in stable pts with no acute EKG changes and no cardiac biomarker elevations

Question 50

what is the definitive diagnostic procedue?

Answer 50

coronary angiography (but use selectively bc of cost)

Question 51

what is the best test ot quantify the extent of an infarct?

Answer 51

MRI with gadolinium

Question 52

what is the initial tx of ACS in pts w/ ongoing discomfort

Answer 52

IV fluids, O2, NTG (.4 mg every 5 mins X3)

Question 53

what can you give pts whose pain is not controlled by NTG?

Answer 53

morphine | some may need sedation w/ a benzo

Question 54

when is IV NTG indictaed?

Answer 54

in the first 48 hours of tx for persisiten ischemia, heart failure, or HTN

Question 55

when should a BB, ACE be initiated?

Answer 55

w/in the first 24 hours

Question 56

what are contraindications for a BB?

Answer 56

Heart failure, bradycardia, heart block

Question 57

what can a CCB be sued for?

Answer 57

to control persisiten or frequently reurring ischemic sx in pts w/ CI to nitrates or BB

Question 58

STEMI tx

Answer 58

ASA and clopidogrel | coronary angiography and primary PCI in 90 mins

Question 59

when should thrombolytic theraby be initiated in a STEMI pt?

Answer 59

first 3 hours after teh onset of pain

Question 60

what are commonly used thrombolytic tx?

Answer 60

alteplase, reteplase, tenecteplase

Question 61

what are absolute CI for thrombolytic tx?

Answer 61

previous hemorrhagic stroke, a stroke witin the past yr, known intracranial neoplasm, active internal bleed, aortic dissection

Question 62

what are relative CI for thrombolytic tx?

Answer 62

known bleeding diathesis, trauma w/in the past 2-4 wks, major surgery, prolonged or traumatic cardiopulmonary resuscitation, recent internal bleed, noncompressible vasculr punctur, diabetic retinoparhy, prego, PUD, current use of anticoag, BP > 180/110

Question 63

what drug can you give to lower someones BP before Tpa?

Answer 63

lobatalol

Question 64

what is the tx for a UA or NSTEMI?

Answer 64

antiplatelet tx: ASA clopidogrel antigoag: enoxaparin or fondaparinux can consider tx w/ IV glycoprotein IIv/IIIa inhibitors, eptifibatide or tirofiban

Question 65

invasive tx for UA/NSTEMI?

Answer 65

cardiac cath