Myocardial Infarction - Johnston Flashcards
What are the cardinal signs of CV diseases?
- Chest pain
- Dyspnea, orthopnea, paroxysmal, nocturnal dyspnea, wheezing, cough, hemoptysis
- Fatigue, weakness
- Pain in extremities with exertion
ST segment elevation indicates what kind of occlusion?
transmural –> Acute MI
What are some causes of MI?
atherosclerosis (most common); other include vasospasm (broken heart syndrome); vasculitis, dissection, genetics
What are some cardinal signs of MI?
- chest discomfort, heavy, pressure, crushing etc
- Retrosternal, left, across chest; neck jaw, left arm, epigastrium
- Nausea, vomiting, diaphoresis, dyspnea
- not relieved by nitro or rest
(keep in mind 20% of AMI are painless as seen in diabetics elderly woman)
Signs of new heart failure includes _
- S3 gallop
- crackles in lungs
- increased JVD
- new murmur
S4 gallop indicates _
atria beating forcefully against a less compliant ventricle as heart after an MI
Sympathetic hyperactivity (increased BP and HR) are seen in _ Mi
anterior
Parasympathetic hyperactivity (bradycardia, decreased BP) is seen in _ MI
inferior
Distinguish between NSTEMI and NSTE ACS
NSTEMI: ST segment depression, T wave inversion, chest pain, elevated cardiac enzymes
NSTE ACS: aka unstable angina; ST segment depression, T wave inversion, chest pain; normal cardiac enzymes
In early phase of acute MI what EKG changes are seen ?
- T wave increase amplitude
- hyperacute-pattern
- convex upward ST pattern
Besides MI what are some other causes of ST segment elevation?
- Pericarditis
- LVH with J point elevation
- Normal variant early repolarization
- Some blacks normally have ST elevation slightly
Persistent ST elevation (after 2 weeks) indicates _
ventricular aneurysm
During ischemia how does the T wave appear?
inverted T waves and tall, peaked T waves
Fireman’s hat looking QRS think
AMI
Significant Q waves and T waves inversion in leads II, III, and AVF indicates
Diaphragmatic or inferior infarct associated with RCA occlusion
how would you recognized necrosed tissue after an MI?
NO R wave, just QS wave.
HOw can you tell where the Acute MI occurring?
Look for where the T waves are inverted: inferior = 2,3,F; Lateral = 1, L, V5-6
Anterior: V2-6
T waves are never normally inverted in which leads?
V2-6. If you see inverted T wave these in these leads think = pathology
what are some causes of ST depression?
- Subendocardial ischemia
- Stress test
- Digitalis toxicity
Diagnostic features of an MI
- Significant Q waves changes (greater than 1mm in width, and 1/3 normal amplitude)
- STE or ST depression
- Inverted Twaves
What is the standard care for STEMI
-EKG and continuous cardiac monitoring
- IV inseted
- Cardiac enzymes, blood panels, clotting times
- reperfursion, fibrinolysis
- heparin,
MONA
What are the treatments for ACUTE coronary syndrome?
In acute coronary syndrome use “MONA-B”
- morphine
- oxygen
- nitroglycerin
- aspirin
- ACE-inhibitors
- may also use B-blockers, GPIIb/IIIa antagonists and angioplasty
What drugs improve Post-MI mortality rates?
- Aspirin
- B-blockers
- ACE-inhibitors
- ARBs
- HMG-CoA reductase inhibitors (statins)
- NOT calcium channel blockers
After an MI patient should be brought to a cath lab within _ minutes
90
If cath lab is not available fibrinolysis should begin in ER within _ minutes; or transfer the pt to another facility within _ minutes
- 30 minutes
- transfer within 120
Primary PCI are preferred to STEMI with symptoms within _ hours
less than 12
How is reperfusion therapy monitored?
EKG. must see resolving ST elevation within 1-2 hours
What are some contraindications for fibrinolytic therapy?
- Active bleeding or bleeding diathesis
- prior hemorrhagic stroke, ischemic stroke within 3 months
- Intracranial or spinal cord neoplasm or arteriovenous malformation
- suspected or known aortic dissection
- closed head or fascial trauma within 3months
What is the initial medical management choice of drug for STEMI/
aspirin - given at presentation or unless contraindicated
what are some complications of MI/
- recurrent chest pain
- Acute pericarditis (dressler syndrome) - treat with aspirin or other NSAID
- rhythm disturbances ( VF, VT, VT polymorphic)
- Afib (in 1st 24hr)
- Sinus bradycardia (associated with inf wall MI)
- 2nd AV block (associated with inferior wall MI)
- Acute mitral regurg (rupture of papillary muscle)
- New holosystolic murmur (inf MI)
- Septal rupture w/ VSD (associated with anterior MI) – > temponade, LV aneurysm
- arterial emboli from LV aneurysm –> stroke, ischemic bowel
If a pt with hx of MI treated with fibrinolytic therapy develops ventricular tachycardia , what is this finding called on a EKG?
accelerated idioventricular rhythm (AIVR) - benign
What is the leading cause of death from AMI?
heart failure
How can you tell if a pt is having an RV infarction?
- decreased BP, clear lungs, increased JVP
- jussmaul sign (distension of jugular vein on inspiration)
treatment: IV fluids
