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Cardiovascular Med II Final > Myocardial Infarction - Johnston > Flashcards

Myocardial Infarction - Johnston Flashcards

1
Q

What are the cardinal signs of CV diseases?

A
  • Chest pain
  • Dyspnea, orthopnea, paroxysmal, nocturnal dyspnea, wheezing, cough, hemoptysis
  • Fatigue, weakness
  • Pain in extremities with exertion
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2
Q

ST segment elevation indicates what kind of occlusion?

A

transmural –> Acute MI

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3
Q

What are some causes of MI?

A

atherosclerosis (most common); other include vasospasm (broken heart syndrome); vasculitis, dissection, genetics

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4
Q

What are some cardinal signs of MI?

A
  • 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)

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5
Q

Signs of new heart failure includes _

A
  • S3 gallop
  • crackles in lungs
  • increased JVD
  • new murmur
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6
Q

S4 gallop indicates _

A

atria beating forcefully against a less compliant ventricle as heart after an MI

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7
Q

Sympathetic hyperactivity (increased BP and HR) are seen in _ Mi

A

anterior

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8
Q

Parasympathetic hyperactivity (bradycardia, decreased BP) is seen in _ MI

A

inferior

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9
Q

Distinguish between NSTEMI and NSTE ACS

A

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

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10
Q

In early phase of acute MI what EKG changes are seen ?

A
  • T wave increase amplitude
  • hyperacute-pattern
  • convex upward ST pattern
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11
Q

Besides MI what are some other causes of ST segment elevation?

A
  • Pericarditis
  • LVH with J point elevation
  • Normal variant early repolarization
  • Some blacks normally have ST elevation slightly
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12
Q

Persistent ST elevation (after 2 weeks) indicates _

A

ventricular aneurysm

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13
Q

During ischemia how does the T wave appear?

A

inverted T waves and tall, peaked T waves

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14
Q

Fireman’s hat looking QRS think

A

AMI

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15
Q

Significant Q waves and T waves inversion in leads II, III, and AVF indicates

A

Diaphragmatic or inferior infarct associated with RCA occlusion

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16
Q

how would you recognized necrosed tissue after an MI?

A

NO R wave, just QS wave.

17
Q

HOw can you tell where the Acute MI occurring?

A

Look for where the T waves are inverted: inferior = 2,3,F; Lateral = 1, L, V5-6
Anterior: V2-6

18
Q

T waves are never normally inverted in which leads?

A

V2-6. If you see inverted T wave these in these leads think = pathology

19
Q

what are some causes of ST depression?

A
  • Subendocardial ischemia
  • Stress test
  • Digitalis toxicity
20
Q

Diagnostic features of an MI

A
  • Significant Q waves changes (greater than 1mm in width, and 1/3 normal amplitude)
  • STE or ST depression
  • Inverted Twaves
21
Q

What is the standard care for STEMI

A

-EKG and continuous cardiac monitoring
- IV inseted
- Cardiac enzymes, blood panels, clotting times
- reperfursion, fibrinolysis
- heparin,
MONA

22
Q

What are the treatments for ACUTE coronary syndrome?

A

In acute coronary syndrome use “MONA-B”

  • morphine
  • oxygen
  • nitroglycerin
  • aspirin
  • ACE-inhibitors
  • may also use B-blockers, GPIIb/IIIa antagonists and angioplasty
23
Q

What drugs improve Post-MI mortality rates?

A
  • Aspirin
  • B-blockers
  • ACE-inhibitors
  • ARBs
  • HMG-CoA reductase inhibitors (statins)
  • NOT calcium channel blockers
24
Q

After an MI patient should be brought to a cath lab within _ minutes

A

90

25
Q

If cath lab is not available fibrinolysis should begin in ER within _ minutes; or transfer the pt to another facility within _ minutes

A
  • 30 minutes

- transfer within 120

26
Q

Primary PCI are preferred to STEMI with symptoms within _ hours

A

less than 12

27
Q

How is reperfusion therapy monitored?

A

EKG. must see resolving ST elevation within 1-2 hours

28
Q

What are some contraindications for fibrinolytic therapy?

A
  • 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
29
Q

What is the initial medical management choice of drug for STEMI/

A

aspirin - given at presentation or unless contraindicated

30
Q

what are some complications of MI/

A
  • 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
31
Q

If a pt with hx of MI treated with fibrinolytic therapy develops ventricular tachycardia , what is this finding called on a EKG?

A

accelerated idioventricular rhythm (AIVR) - benign

32
Q

What is the leading cause of death from AMI?

A

heart failure

33
Q

How can you tell if a pt is having an RV infarction?

A
  • decreased BP, clear lungs, increased JVP
  • jussmaul sign (distension of jugular vein on inspiration)
    treatment: IV fluids

Cardiovascular Med II Final (9 decks)

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