Myocardial infarction III

Question 1

do arrhythmias occur during STEMIs, NSTEMIs, or both?

Answer 1

both

Question 2

what is the most common type of arrhythmia seen with MI?

Answer 2

ventricular premature

Question 3

what is done for PVCs?

Answer 3

correct electrolytes

beta blockers

Question 4

when is accelerated idioventricular rhythm observed?

Answer 4

shortly after successful reperfusion

Question 5

accelerated idioventricular rhythm is a result of what type of conduction abnormality?

Answer 5

enhanced automaticity of purkinje fibers

Question 6

VT induced by ischemia has what morphology?

Answer 6

polymorphic

Question 7

VT induced by scarring has what morphology?

Answer 7

monomorphic

Question 8

what is the significance of having late VT/VF (after 48 hours) following MI?

Answer 8

increased risk of sudden cardiac death

Question 9

what are the high risk factors for sudden cardiac death?

Answer 9

late VT/VF

EF less than 35% (strongest factor)

Question 10

what is the strongest risk factor for sudden cardiac death?

Answer 10

EF less than 35% when leaving the hospital

Question 11

inferior MIs typically result from a block at what level?

Answer 11

AV node

Question 12

what are three causes of inferior MIs due to AV nodal block?

Answer 12

high parasympathetic tone
local accumulation of K, adenosine
AV node ischemia

Question 13

what is the best management option for acute MI phase of heart failure?

Answer 13

vasodilators (NTG unless hypotensive)

Question 14

what are the three management options for post acute phase of heart failure?

Answer 14

diuretic
ACE inhibitor
aldosterone antagonists (spironolactone, epleronone)

Question 15

what is the treatment for cardioembolism?

Answer 15

anticoagulation with warfarin

Question 16

what type of pain characterizes pericarditis?

Answer 16

pleuritic, can radiate to trapezius

Question 17

what is the treatment for pericarditis?

Answer 17

aspirin (650 mg for 4-6 hours)

Question 18

what treatments should be avoided in pericarditis?

Answer 18

NSAIDs, steroids

Question 19

the syndrome for late pericarditis goes by what name?

Answer 19

dressler’s syndrome

Question 20

what is dressler’s syndrome?

Answer 20

(late) pericarditis plus systemic symptoms (malaise, arthralgias, fever, pleural / pericardial effusions, high sedimentation rate, CRP)

Question 21

what is the mechanism type for dressler’s syndrome?

Answer 21

autoimmune

Question 22

what is the treatment for dressler’s syndrome?

Answer 22

aspirin, colchicine

Question 23

how does auscultation of a VSD differ from mitral regurg?

Answer 23

in VSD the murmur is found at the LLSB as opposed to the apex and typically louder

Question 24

acute mitral regurg is found primarily in the setting of inferior MI involving which papillary muscle?

Answer 24

posteromedial

Question 25

what is the best diagnostic test for mitral regurg?

Answer 25

echo or TEE

Question 26

how can VSD be differentiated from papillary muscle rupture?

Answer 26

VSD - loud holosystolic murmr as LSB
MR - may be faint, more commonly at apex

VSD - can lie flat
MR - cannot lie flat

Question 27

what are the risk factors for free wall rupture?

Answer 27

older 
female 
history of HTN 
first MI 
absent reperfusion

Question 28

echo will show what features for free wall rupture?

Answer 28

pericardial effusion, tamponade

Question 29

true aneurysm

Answer 29

all three layers are present

bulges out

Question 30

which layer holds a pseudoaneurysm in place?

Answer 30

epicardium

Question 31

which type of aneurysm has a higher risk of rupture?

Answer 31

pseudoaneurysm

Question 32

what are the goals of an intra-aortic pump?

Answer 32

1. augments coronary blood flow during diastole
2. decreases afterload during systole by deflating at onset of systole
3. reduces myocardial ischemia by both mechanisms