Myocardial Ischemia Flashcards
1st sign of CAD
Stable Angina
What is CAD
Any disease that narrows or occludes one or more cornary artery
When does stable Angina present
50% or more occlusion
What happens to angina pain?
Goes away quickly with rest or nitro
ST depression can be when pain is present
Cardiac Enzymes in Stable angina
Normal
Released from dead cardiac cells - no cardiac ischemia here
Unstable Angina occurs at
80% or greater occlusion
Unstable Angina can happen
at rest or minimal activity
Unstable Angina can have what on EKG
T wave inverisons- indicate a prolonged ischemia >20 mins
What cardiac enzymes are w/ unstable angina
None - again no cellular death
What begins to happen to cells at NSTEMI
Cell death
NSTEMI occurs at
95% or greater occlusion
NSTEMI EKG changes
ST depression or T wave abnormalities - but not classi
NSTEMI SA
Pain
STEMI EKG
ST segment elevation
what happens when you have a blockage of your LAD
Blockage of the front of your left ventricle
STEMI leads
v3 and v4
Frequent presentation of an LAD Anterior MI
Left ventricular failure - can’t pump, front wall not compressing against the back
Where does Circumflex artery go?
Under your arm - lateral/side part of your heart
What leads go on circumflex artery
V5 & V6
What does the circumflex artery do during a lateral MI
Buldges - can’t compress
Presentation of circumflex lateral MI
Cardiogenic shock
R ventricle sits beside
the mediumstinum
Where does the right marginal artery sit?
Bottom of your heart
What is another name for right marginal artery MI
Inferior MI
Artery that gives main blood source to AV Node
Right Marginal Artery
3 leads for inferior MI
II, III, aVF
Inferior MI complications
Heart blocks - main blood source for AV node
Posterior Descending Artery causes
blockage of back of heart
Can you see EKG changes on posterior MI?
No you don’t put leads on the back
What happens during posterior MI for contracility
Right posterior side buldges - can’t contract
Shows signs of RV failure
What happens to R wave in posterior MI
R wave goes from big to small - R wave progression
Tall V1
Small V6
MI V7, V8. V9?
EKG being done on back below scapula
Posterior MI
Vagal nerve runs from…
Down mediumsteinum, border Right ventricle on the way to the diaphragm - hugs R ventricle
What can happen to the vagal nerve during a Right Ventricle MI
Ischemia can irritate the vagal nerve and cause parasympathetic stiumulation
What does Left Ventricle MI stimulate?
Left sided heart has a decrease in CO therefore stimulating sympathetic
Nausea/Vomiting
Right Side
JVD
Right Side
Diaphoresis
Left Side
Dyspnea/Orthopena
Left Side
Tachycardia/HTN
Left Side
Bradycardia/Hypotension
Right Side
Electrode placement for right sided MI
Move the left sided stickers to the right side
O2 be put on both R and L MI?
Yes - for 02 sat of 92%
ASA for both R and L MI?
Yes - chewable 162-325
NTG spray or SL for both R and L MI?
ONLY RIGHT
Vasodilator
Contraindicated in a pulse >50 and SBP >90
When should you not use nitro for an Left sided MI?
IF a phosphodiesterase (Cialis / Viagra) inhibitor has been used within the past 24 hours
- Hypotension refractory to tx
If Left MI does not respond to nitro?
Morphine
Fluid boluses for L or R MI?
R because vasodilation - pressure is low - elevate pressure
Percutaneous Coronary Interventions for L or R MI?
Both - Tx less than 90 mins from onset of pain
Fibrinolytic for L or R MI?
Both - IF PCI is delayed
What is PCI
Stent placement into narrowing blood vessels due to plaque build up
