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2nd Semester Final > Myocardial Infarction Lecture Powerpoint > Flashcards

Myocardial Infarction Lecture Powerpoint Flashcards

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1
Q

Why do post menopausal women have an increased risk of CAD?

A

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

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2
Q

HS-CRP vs CRP

A

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

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3
Q

Lowering CRP decreases risk of stroke by ___% and MI by ___% as studied in the ____ trial

A

48, 38, Jupiter

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4
Q

Precipitating factors for acute myocardial infarction (5) and what is the most common of them?

A
  • Physical stress (30%)
  • Post surgical (5%)
  • sleep (10%)
  • emotional stress (20%)
  • rest (NO precipitating factor, 50%)***
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5
Q

Peak hours for acute myocardial infarction and why?

A

early morning, thought to be tied to circadian rhythm and increase in sympathetic activity following waking

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6
Q

What are the common causes of chest pain? (5)

A
  • MI
  • Aortic dissection
  • PE
  • esophageal rupture
  • pneumothorax
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7
Q

Most common cause of transmural acute myocardial infarction

A

acute coronary thrombus

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8
Q

The hallmark of a previous acute myocardial infarction is development of what on an EKG?

A

…Q wave in leads corresponding to region of the heart (for example lead II, III and AVF)

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9
Q

3 separate cardiac enzymes tests (name the specific one) need to be done 6-12 hours apart to definitively rule out ____

A

troponin T, Myocardial Infarction

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10
Q

2 Inhibitors used to prevent platelet activation in acute MI

A
  • chewed ASA

- clopidogrel (plavix)

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11
Q

Lupus systemic erythmatosus ____ possibility of MI by ___x

A

increases, 16

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12
Q

Type I MI

A

Caused by acute atherothrombotic coronary artery disease usually precipitated by atherosclerotic plaque disruption

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13
Q

Type 2 MI

A

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

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14
Q

Type 3 MI

A

Undiagnosed MI resulting in death before any obtaining of biomarker values to determine type otherwise

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15
Q

Type 4a MI

A

MI associated with percutaneous coronary intervention (PCI)

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16
Q

Type 4b MI

A

Subcategory of percutaneous coronary intervention related MI due to stent or scaffold thrombosis

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17
Q

Type 5 MI

A

MI related to coronary artery bipass graft

18
Q

Type II diabetic may not get chest pain but a silent MI presenting as…

A

….SOB and fatigue, or asymptomatic

19
Q

Inferior wall MI (right ventricle infarct due to occlusion of posterior descending artery) triad of presentation

A
  • JVD increasing on inspiration (kussmaul’s sign)
  • Hypotension
  • Clear lung fields upon auscultation
20
Q

Clinical stratification classification of MI (4)

A

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

21
Q

Triad of acute MI presentation

A
  • prolonged chest pain >30 min
  • ST elevation >2 consecutive leads
  • Positive cardiac enzyme test
22
Q

TIMI Risk score classification system for MI (what MI types is it for, and list the values)

A

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

23
Q

Highest risk factor for Myocardial infarction

A

Smoking

24
Q

Sublingual nitroglycerine for acute MI can be delivered only if SBP is greater than…

A

…90mmHg

25
Q

Percutaneous coronary intervention needs to be completed within ___ min for patients transported to PCI capable hospital

A

90 min

26
Q

Absolute contraindications of thrombolysis in acute myocardial infarction (4)

A
  • active internal bleeding
  • intracranial neoplasm or recent head trauma
  • pregnancy
  • history of CVA
27
Q

Thrombolytic therapy for acute myocardial infection requires administration of what alongside it?

A

-IV heparin

28
Q

Indications for CABG for acute myocardial infarction (2)

A
  • 3 vessels disease

- left main disease

29
Q

Some post MI complications (4)

A
  • sinus tachycardia
  • recurrent ischemia
  • pericarditis
  • Dressler’s syndrome
30
Q

Dressler’s syndrome

A

2ndary pericarditis to MI characterized by malaise, fever, and pericardial pain

31
Q

Key distinguishing finding to determine between RV infarct and HF

A

-The lungs are clear upon auscultation in RV infarct despite the increased JVD and hypotension, while the lungs are not clear sounding in HF

32
Q

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

A
  • nitroglycerin
  • aspirin chewable
  • B blocker

-NITROGLYCERIN

33
Q

2 Medications for 1 year following placement of drug eluding stent

A
  • aspirin daily

- plavix

34
Q

4 medications for 1 month following bare metal stent placement

A
  • ACEI or ARB
  • B blocker
  • Statin
  • Sublingual Nitroglycerin as needed
35
Q

the only degree AV block that requires a pacemaker is ___ degree

A

3rd

36
Q

Unstable angina will have ___ cardiac biomarkers while STEMI and Non-STEMI will have ___ ones.

A

Negative, positive

37
Q

Why do we have patients receiving ASA for MI chew the aspirin?

A

It helps activation occur faster

38
Q

Top 3 diagnostic tests for acute MI

A
  • EKG
  • Chest Xray
  • Echocardiogram
39
Q

Management of AMI in ER list (13 steps!)

A
  • 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
40
Q

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

A

200, 100, 70, 40, 60

2nd Semester Final (207 decks)

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