Myocardial infarction III Flashcards
do arrhythmias occur during STEMIs, NSTEMIs, or both?
both
what is the most common type of arrhythmia seen with MI?
ventricular premature
what is done for PVCs?
correct electrolytes
beta blockers
when is accelerated idioventricular rhythm observed?
shortly after successful reperfusion
accelerated idioventricular rhythm is a result of what type of conduction abnormality?
enhanced automaticity of purkinje fibers
VT induced by ischemia has what morphology?
polymorphic
VT induced by scarring has what morphology?
monomorphic
what is the significance of having late VT/VF (after 48 hours) following MI?
increased risk of sudden cardiac death
what are the high risk factors for sudden cardiac death?
late VT/VF
EF less than 35% (strongest factor)
what is the strongest risk factor for sudden cardiac death?
EF less than 35% when leaving the hospital
inferior MIs typically result from a block at what level?
AV node
what are three causes of inferior MIs due to AV nodal block?
high parasympathetic tone
local accumulation of K, adenosine
AV node ischemia
what is the best management option for acute MI phase of heart failure?
vasodilators (NTG unless hypotensive)
what are the three management options for post acute phase of heart failure?
diuretic
ACE inhibitor
aldosterone antagonists (spironolactone, epleronone)
what is the treatment for cardioembolism?
anticoagulation with warfarin
what type of pain characterizes pericarditis?
pleuritic, can radiate to trapezius
what is the treatment for pericarditis?
aspirin (650 mg for 4-6 hours)
what treatments should be avoided in pericarditis?
NSAIDs, steroids
the syndrome for late pericarditis goes by what name?
dressler’s syndrome
what is dressler’s syndrome?
(late) pericarditis plus systemic symptoms (malaise, arthralgias, fever, pleural / pericardial effusions, high sedimentation rate, CRP)
what is the mechanism type for dressler’s syndrome?
autoimmune
what is the treatment for dressler’s syndrome?
aspirin, colchicine
how does auscultation of a VSD differ from mitral regurg?
in VSD the murmur is found at the LLSB as opposed to the apex and typically louder
acute mitral regurg is found primarily in the setting of inferior MI involving which papillary muscle?
posteromedial
what is the best diagnostic test for mitral regurg?
echo or TEE
how can VSD be differentiated from papillary muscle rupture?
VSD - loud holosystolic murmr as LSB
MR - may be faint, more commonly at apex
VSD - can lie flat
MR - cannot lie flat
what are the risk factors for free wall rupture?
older female history of HTN first MI absent reperfusion
echo will show what features for free wall rupture?
pericardial effusion, tamponade
true aneurysm
all three layers are present
bulges out
which layer holds a pseudoaneurysm in place?
epicardium
which type of aneurysm has a higher risk of rupture?
pseudoaneurysm
what are the goals of an intra-aortic pump?
- augments coronary blood flow during diastole
- decreases afterload during systole by deflating at onset of systole
- reduces myocardial ischemia by both mechanisms
