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Urgent Care/Critical Care (inpt) > Myocardial Infarction > Flashcards

Myocardial Infarction Flashcards

1
Q

what is the most common manifestation of coronary artery dz?

A

ACUTE MI

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2
Q

PP of acute MI

A

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

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3
Q

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

A

STEMI

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4
Q

what happens if STEMI is untx?

A

necrosis of myocardium, pathogen Q waves

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5
Q

in NSTEMI, what is absent comparted to STEMI

A

Q waves

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6
Q

unstable angina ?

A

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

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7
Q

stable angina pectoris

A

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

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8
Q

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

A

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

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9
Q

ST segment changs w/o angina?

A

70% chance of sign CAD

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10
Q

stress testing important thing to watch for

A

drop in SBP > 10 mmhg

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11
Q

laboratory data for stable angina

A

*cardiac enzymes should BE NEGATIVE

CK, CKMB, troponin

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12
Q

Acute Coronary Syndromes?

A

unstable angina to MI

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13
Q

MI

A

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

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14
Q

what do most ts die of during an MI

A

V FREAKIN FIB

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15
Q

what population may present abnormally during an MI?

A

women, DM, and elderly

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16
Q

what sx may elderly ppl have?

A

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

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17
Q

unstable angina sx

A

new, sudden onset CP, pressure

  • cP at rest or nocturnally,
  • CP that used to be controled w. nitrates
  • CP at greater frequeny
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18
Q

Unstable angina diagnosits findings?

A

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

again, cardiac enzymes are negative

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19
Q

tx of unstable angina

A

admit, monitor, bed rest/ox

**want to risk stratify w/ cardiac cath

Plavix (clopidogrel)

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20
Q

NSTEMI CF

A
  • 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
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21
Q

Wellen sign

A

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

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22
Q

DX NSTemi

A

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

ST segment depression

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23
Q

TIMI risk score

A
  • 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
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24
Q

STEMI

A

caused by thrombotic obsturction of epicardial coronary arteries

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25
Q

pe for a stemi

A

HTN, hypotension, tachy or brady, S3/S4, signes of CHF (pulmonary edema)
friction rub

-basilar rales or other findings of pulmonary edema

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26
Q

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

A

MR, VSD

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27
Q

ST segment elevations w/in mins?

A

acute transmural ischemia

28
Q

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

A

irreversible necrosis

29
Q

what happens to the T waves after a few weeks?

A

repolarzie and return upright

30
Q

changes in leads II, III, aVF

A

inferior

*RCA, Left circumflex if left dominant

31
Q

leads V2-V5

A

anterior

LAD

32
Q

leades I avL, V5-V6

A

lateral

left circumflex

33
Q

leads II, III, AVF, I AVL

A

inferolateral

Large RCA or left dominant left circumflex

34
Q

V4-V6, I AvL

A

anterlateral

V4-V6, I , avL

left circumflex

35
Q

Dressler Sydrome

A

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

36
Q

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

A

low-grade fever after 12 hours

friction rub after 24 hour

37
Q

what is the widow maker artery?

A

LAD

38
Q

what would a stemi look like on an EKG?

A

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

39
Q

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

A

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

40
Q

what will NTEMI pts develop on the EKG?

A

non-Q wave MI, but some will show this

41
Q

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?

A

acute ischmia or CAD

42
Q

what is a new LBBB on EKG suspicious for?

A

new MI

43
Q

what is the most specific cardiace biomarker for myocardial damage?

A

troponin T and or troponin I

44
Q

what is an important biomarker if a reinfarction is suspected?

A

CK-MB

45
Q

when is it important to measure the myoglobine levels?

A

if pt presents less than 6 hours after sx onset

46
Q

when should the troponin levels be measures?

A

8-12 hours after ACS and during initial sx

47
Q

what would an Echo show?

A

abnormalities of the cardiac wall motion or MR

48
Q

what would a CXR show?

A

indicate pulmonary vascular congestion or signs of aortic dissection

49
Q

when would you do a stress test?

A

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

50
Q

what is the definitive diagnostic procedue?

A

coronary angiography (but use selectively bc of cost)

51
Q

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

A

MRI with gadolinium

52
Q

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

A

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

53
Q

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

A

morphine

some may need sedation w/ a benzo

54
Q

when is IV NTG indictaed?

A

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

55
Q

when should a BB, ACE be initiated?

A

w/in the first 24 hours

56
Q

what are contraindications for a BB?

A

Heart failure, bradycardia, heart block

57
Q

what can a CCB be sued for?

A

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

58
Q

STEMI tx

A

ASA and clopidogrel

coronary angiography and primary PCI in 90 mins

59
Q

when should thrombolytic theraby be initiated in a STEMI pt?

A

first 3 hours after teh onset of pain

60
Q

what are commonly used thrombolytic tx?

A

alteplase, reteplase, tenecteplase

61
Q

what are absolute CI for thrombolytic tx?

A

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

62
Q

what are relative CI for thrombolytic tx?

A

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

63
Q

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

A

lobatalol

64
Q

what is the tx for a UA or NSTEMI?

A

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

65
Q

invasive tx for UA/NSTEMI?

A

cardiac cath

Urgent Care/Critical Care (inpt) (8 decks)

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