Myocardial Infarction Lecture Powerpoint Flashcards
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Why do post menopausal women have an increased risk of CAD?
Estrogen plays a role in increasing HDL levels and because it is absent post menopause it changes the female’s risks to that of male equivalents
HS-CRP vs CRP
High sensitivity CRP is a test that allows for detection of markers in lower grade conc than CRP and is theorized to be a better predictor of MI than CRP as a result, both are nonspecific inflammatory markers that can be present regardless of MI
Lowering CRP decreases risk of stroke by ___% and MI by ___% as studied in the ____ trial
48, 38, Jupiter
Precipitating factors for acute myocardial infarction (5) and what is the most common of them?
- Physical stress (30%)
- Post surgical (5%)
- sleep (10%)
- emotional stress (20%)
- rest (NO precipitating factor, 50%)***
Peak hours for acute myocardial infarction and why?
early morning, thought to be tied to circadian rhythm and increase in sympathetic activity following waking
What are the common causes of chest pain? (5)
- MI
- Aortic dissection
- PE
- esophageal rupture
- pneumothorax
Most common cause of transmural acute myocardial infarction
acute coronary thrombus
The hallmark of a previous acute myocardial infarction is development of what on an EKG?
…Q wave in leads corresponding to region of the heart (for example lead II, III and AVF)
3 separate cardiac enzymes tests (name the specific one) need to be done 6-12 hours apart to definitively rule out ____
troponin T, Myocardial Infarction
2 Inhibitors used to prevent platelet activation in acute MI
- chewed ASA
- clopidogrel (plavix)
Lupus systemic erythmatosus ____ possibility of MI by ___x
increases, 16
Type I MI
Caused by acute atherothrombotic coronary artery disease usually precipitated by atherosclerotic plaque disruption
Type 2 MI
Consequent to mismatch between o2 supply and demand due to things other than a plaque such as coronary dissection, vasospasm, embolism (a non-plaque one), microvascular dysfunction, or increased demand with or without underlying CAD
Type 3 MI
Undiagnosed MI resulting in death before any obtaining of biomarker values to determine type otherwise
Type 4a MI
MI associated with percutaneous coronary intervention (PCI)
Type 4b MI
Subcategory of percutaneous coronary intervention related MI due to stent or scaffold thrombosis
Type 5 MI
MI related to coronary artery bipass graft
Type II diabetic may not get chest pain but a silent MI presenting as…
….SOB and fatigue, or asymptomatic
Inferior wall MI (right ventricle infarct due to occlusion of posterior descending artery) triad of presentation
- JVD increasing on inspiration (kussmaul’s sign)
- Hypotension
- Clear lung fields upon auscultation
Clinical stratification classification of MI (4)
Killip Class I - no pulmonary congestion and no shock
Killip class II - mild pulmonary congestion and S3 presence
Killip class III - pulmonary edema and extensive LV dysfunction
Killip Class IV - hypotension and cardiogenic shock
Triad of acute MI presentation
- prolonged chest pain >30 min
- ST elevation >2 consecutive leads
- Positive cardiac enzyme test
TIMI Risk score classification system for MI (what MI types is it for, and list the values)
A system that detects presence of risk factors for CHD in patients with unstable angina or acute NSTEMI
low risk 0-2, moderate risk 3-4, high risk 5-7
Highest risk factor for Myocardial infarction
Smoking
Sublingual nitroglycerine for acute MI can be delivered only if SBP is greater than…
…90mmHg
Percutaneous coronary intervention needs to be completed within ___ min for patients transported to PCI capable hospital
90 min
Absolute contraindications of thrombolysis in acute myocardial infarction (4)
- active internal bleeding
- intracranial neoplasm or recent head trauma
- pregnancy
- history of CVA
Thrombolytic therapy for acute myocardial infection requires administration of what alongside it?
-IV heparin
Indications for CABG for acute myocardial infarction (2)
- 3 vessels disease
- left main disease
Some post MI complications (4)
- sinus tachycardia
- recurrent ischemia
- pericarditis
- Dressler’s syndrome
Dressler’s syndrome
2ndary pericarditis to MI characterized by malaise, fever, and pericardial pain
Key distinguishing finding to determine between RV infarct and HF
-The lungs are clear upon auscultation in RV infarct despite the increased JVD and hypotension, while the lungs are not clear sounding in HF
You can give any patient with acute angina, NSTEMI or STEMI these 3 drugs except in hypotensive RV infarcts where ___ (which one of them?) is contraindicated
- nitroglycerin
- aspirin chewable
- B blocker
-NITROGLYCERIN
2 Medications for 1 year following placement of drug eluding stent
- aspirin daily
- plavix
4 medications for 1 month following bare metal stent placement
- ACEI or ARB
- B blocker
- Statin
- Sublingual Nitroglycerin as needed
the only degree AV block that requires a pacemaker is ___ degree
3rd
Unstable angina will have ___ cardiac biomarkers while STEMI and Non-STEMI will have ___ ones.
Negative, positive
Why do we have patients receiving ASA for MI chew the aspirin?
It helps activation occur faster
Top 3 diagnostic tests for acute MI
- EKG
- Chest Xray
- Echocardiogram
Management of AMI in ER list (13 steps!)
- Obtain history
- perform physical exam
- order diagnostic tests such as EKG, chest xray and echocardiogram
- supplemental O2 as necessary
- Morphine administration for pain control
- 2 IV lines
- chewable aspirin or plavix if allergic
- Sublingual nitroglycerine
- Potentially IV nitroglycerine if no relief
- IV B blocker metoprolol 5mg every 2-5 min for 3 doses
- statins
- ACE inhibitors
- Consider percutaneous coronary intervention, CABG, or thrombolytics
Total cholesterol should be below ___. LDL should be below ___ or ____ in patients with CAD. HDL should be greater than ____, but greater than ___ is even better
200, 100, 70, 40, 60
