Myocardial infarction

Question 1

What are the three major risk factors for my cardio infarction in pregnancy

Answer 1

Age > 30 years
Hypertension
Diabetes

Question 2

Majority of acute myocardial infarction occurs during which period in pregnancy

Answer 2

80% occur in antepartum or postpartum.

Question 3

List other common findings with myocardial infarction

Answer 3

40% will have atherosclerosis
27% will have coronary artery dissection
21% will have a coronary thrombosis
13 to 29% have normal coronary arteries

Question 4

How is the cute myocardial infarction diagnosed

Answer 4

Elevated troponin and or elevated CKMB levels

Abnormal electrocardiogram most associated with ST segment elevation

Question 5

Less recommended work ups for acute myocardial infarction

Answer 5

Echocardiogram to exclude unrecognized structural cardiac abnormality and to evaluate for ventricular function
Electrocardiogram to establish ST segment elevation or depression and Q wave abnormalities
Laboratory work up should include troponin CKMB, CBC, PTINR, APTT, Electrolytes, magnesium, BUN, creatinine, blood glucose and serum lipid profile

Question 6

List potential complications of acute myocardial infarction

Answer 6

Cardiac arrest
Maternal mortality 5 to 7% if in hospital myocardial infarction
Cardiac failure or dysrhythmia

Question 7

What is the initial management of acute myocardial infarction

Answer 7

Goal is to complete Mona therapy in less than 10 minutes of diagnosis
M is for morphine 2 to 4 mg IV
O is for oxygen via nasal cannula or mask
N is for nitroglycerin 0.5 mg sublingual every five minutes times 3
A is for aspirin 160 mg to 325 mg by mouth and chewed

Question 8

When should an electrocardiogram be repeated if initial electrocardiogram it is normal and acute myocardial infarction is suspected

Answer 8

Follow 12 lead electrocardiogram in 5 to 10 minutes after the initial electrocardiogram

Question 9

What is the management of newly discovered ST elevation or new left bundle branch block

Answer 9

Treat as though patient has acute myocardial infarction in consultation with cardiologists
Give the following:
Beta blockers
IV nitroglycerin
IV heparin
Antiplatelet therapy such clopidogrel
Morphine IV to treat pain
Anti-thrombin therapy
Consider reperfusion therapy
Fetal monitoring if viable

Question 10

When should Delivery occur post an acute myocardial infarction

Answer 10

Expert opinion recommend postponing delivery for 2 to 3 weeks post infarction to minimize additional cardiac demands

Question 11

What are some labor and delivery considerations for a patient with acute myocardial infarction

Answer 11

If Vaginal delivery attempted consider assisted second stage to minimize cardiac workload
Avoid hypertension or tachycardia
Avoid methergine and prostaglandins as they may cause coronary vasoconstriction