Presentation And Tx Of Acute MI Flashcards

1
Q

Morphine

A

Used to control pain associated with acute MI

  • reduces afterload and preload
  • reducing the preload may improve angina symptoms and chest pain
  • controversial useage since some studies show increased mortality
  • primarily used in the setting of angina and MI, is controversial in the use of Heart block and hypotension due to decreasing blood pressure*
  • however for testing and boards purposes, use morphine for these incidents
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2
Q

Treatment of STEMIs

A

Need treatment before 3hrs

  • 50% reduction in mortality if treated before 3 hrs
  • can treat up to 12 hrs after onset of symptoms

Goal of treatment is to limit infarct size and preserve left ventricular function

Treatment options =

1) fibrinolysis ( only serious incidents)
- requires door-needle time less than 30 min
- includes tenecteplase or reteplase w/ coadministration of HMW heparin or P2Y12 inhibitors

2) percutaneous coronary interventions (STENTS Or valvular angioplasty)
- this is preferred option unless it cant be done

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3
Q

Contraindications of fibrinolysis drugs (tPA)

A

History of brain hemorrhages

History of strokes less than 3 months ago

Aortic dissection is likely

Active bleeding currently

Severe uncontrolled hypertension (>180/>110)
- must fix first, then treat

Significant head trauma

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4
Q

Indications for fibrinolytic therapy

A

1) Onset of STEMI within 12 hrs without contraindications
- most effective within 90 min of symptoms

2) new LBBBs

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5
Q

PCI

A

Includes angioplasty, valvuloplasty and stenting

  • often used in acute coronary syndromes over tPA (unless PCI cannot be done within 90 minutes) since it has low contraindications
  • must use in cardiogenic shock

also requires duel anti-platlet therapy for 12 months (asprin and P2Y12 inhibitor)

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6
Q

When to choose PCI over Fibrinolytics?

A

When in doubt use PCI over fibrinolytics as long as its possible

only time for fibrinolytics is when PCI is not possible within 90 min.
- possess higher mortality so is less safe

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7
Q

What rhythm is most common in ECGs after reperfusion?

A

Accelerated idioventricular rhythm

  • this is usually limited and is more of a good sign that treatment worked
  • DONT treat, just let it resolve
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8
Q

What types of MIs can result in AV blocks?

A

1) Inferior MI w/or without posterior MI
- blockage of the RCA blocks blood flow to the SA/AV nodes

2) anterior MI
- more dangerous than inferior MI blockage

consider using atropine, however may not respond

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9
Q

What type of MI results in LBBB sometimes?

A

Anterior MI

If MI + new LBBB = treatment for acute MI (lidocaine primarily)

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10
Q

Pericarditis

A

Visceral/parietal layers have infection/inflammation
- pain decreases w/ sitting up

Is called Dressler syndrome if it occurs after post MIs
- generates pericarditis and/or pleural effusions via inflammation or immune related interactions

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11
Q

Ventricular aneurysm on an ECG

A

Persistent ST elevation in the anterior leads often present w/ Q WAVES (PAST MI)

Usually caused by mural thrombosis so treatment consists of anticoagulants to break up the thrombosis

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12
Q

Treatment for right ventricular infarct

A

Blood supply occluded = RCA (85%), left circumflex (15%)

Presents with distended neck veins, clear lungs and hypotension

ECG abnormalities = ST elevation in V1-2 ; ST elevation greater in lead 3 than lead 2

To:

  • PCI if severe (shows signs of heart failure)
  • IV bolus of lidocaine, BBs or CBBs, fluid overload overtime

DONT use nitrates or morphine (since these increase preload to a failing right ventricle)

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13
Q

Tx for post myocardial infarction

A

Usually Lifelong aspirin and/or P2Y12 (“Grel”)
- If stent placed, must use for 1 yr regardless

BBs are required to be started within 24 hrs after unless contraindications
- often used for life as well

Lifelong statins

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14
Q

Why is nitroglycerin used for burning/pain in the chest

A

Nitrates decrease myocardial preload as their primary effect
- do this by increasing venous capacitance and induce venous pooling

Most pain/burning is caused by increased preload/ oxygen demand is higher than cardiac supply

CONTRAINDICATED in right ventricular infracts

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15
Q

Leads that show ST elevation for a septal/anterior MI?

A

V1-4 will show ST elevation

  • Left anterior descending artery is occluded
  • just need 2 leads*
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16
Q

Leads that show ST elevation for a lateral MI

A

V5/6 and AVL will show ST elevation

  • left circumflex artery is occluded
  • just need 2 leads*
17
Q

Leads that show ST elevation for a inferior MI

A

2/3 and AVF will show ST elevation

  • the artery occluded is the RCA
  • just need 2 leads*
18
Q

Q waves in ECG

A

Consistent with previous MIs or with present transmural myocardial infarcts

  • if Q waves are present, they will line up with the site of the MI (ex: Q waves in 2/3/AVF = inferior current or past Myocardial infarction)
19
Q

Statistics surrounding missed acute MIs

A

2-4% of patients are discharged with missing acute MI diagnosis
- accounts for the largest amount of malpractice payouts w/ emergency personal

People who are 1 or more of the following tend to be missed more often

  • younger
  • woman
  • non-white
  • poor ECG readings
20
Q

Dresser syndrome

A

Pericarditis that occurs post MIs

- high chance for pericardial and pleural effusions than normal pericarditis

21
Q

What does mitral regurgitation look like on an ECG?

A

Will be hypotensive and new holosystolic murmur

ECG changes

  • depressed ST in 1/aVL/V3/V4 (around mitral area of the heart)
  • ST elevations in aVF/3/2