Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiology Secrets > ST-ELEVATION MYOCARDIAL INFARCTION > Flashcards

ST-ELEVATION MYOCARDIAL INFARCTION Flashcards

1
Q

What are the electrocardiographic criteria for the diagnosis of ST-segment elevation myocardial infarction (STEMI)?

A

ST-segment elevation greater than 0.1 mV in at least two contiguous leads, new or presumably new left bundle branch block (LBBB)

ACCF/AHA criteria specify ST elevation in leads V2–V3 to be ≥0.25 mV in men under 40, ≥0.2 mV in men over 40, or ≥0.15 mV in women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the significance of leads V7–V9 in diagnosing STEMI?

A

Leads V7–V9 are used to assess ST elevation in cases of suspected left circumflex artery occlusion

These leads are positioned on the back below the scapula.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Is intracoronary thrombus common in STEMI?

A

Yes, seen in more than 90% of STEMI patients

This is due to plaque rupture and thrombus formation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does primary PCI refer to?

A

The strategy of taking a STEMI patient directly to the cardiac catheterization laboratory for mechanical revascularization

This bypasses thrombolytic therapy in the emergency room.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is door-to-balloon time?

A

The time from when a STEMI patient arrives at the emergency room to when a balloon is inflated in the occluded coronary artery

The goal is 90 minutes or less for direct hospital presentations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is door-to-needle time?

A

The time from when a STEMI patient arrives at the emergency room to the start of thrombolytic therapy

The target is 30 minutes or less.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are absolute contraindications to thrombolytic therapy?

A

• Any prior ICH
• Known structural cerebral vascular lesion
• Known malignant intracranial neoplasm
• Ischemic stroke within 3 months
• Suspected aortic dissection
• Active bleeding
• Significant closed-head or facial trauma within 3 months
• Intracranial or intraspinal surgery within 2 months
• Severe uncontrolled hypertension
• For streptokinase, prior treatment within 6 months

ICH refers to intracranial hemorrhage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which patients with STEMI should undergo immediate coronary angiography?

A

Patients who are candidates for primary PCI, those with severe heart failure or cardiogenic shock, and those with evidence of failed fibrinolysis

Hemodynamically stable patients with successful fibrinolysis may also be candidates.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is rescue PCI?

A

The performance of PCI after a patient has failed thrombolytic therapy

It shows modest benefits in appropriately selected patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the goal for medical contact-to-device time in STEMI cases?

A

90 minutes or less for direct hospital presentations, 120 minutes if transferring from a non-PCI hospital

This reflects the time from medical contact to intervention.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Should complete revascularization be pursued in patients with STEMI and multivessel coronary artery disease?

A

Yes, complete revascularization is superior to culprit lesion-only PCI in reducing adverse events

However, this does not apply to those with cardiogenic shock.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the criteria for primary PCI in patients with STEMI?

A

STEMI symptoms within 12 hours, severe heart failure or cardiogenic shock, contraindications to fibrinolytic therapy

Asymptomatic patients presenting between 12 and 24 hours may also be considered.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a patent infarct artery?

A

An infarct artery that remains open 3–24 hours after fibrinolytic therapy

This indicates successful treatment but may still require monitoring for ischemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the recommended treatment strategy for patients with STEMI presenting to rural hospitals without PCI capability?

A

Primary PCI is preferred if transfer to a facility with PCI capabilities can be done within 120 minutes; otherwise, fibrinolytic therapy is advised

Urgent or elective transfer for angiography should occur within 24 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does DIDO stand for in the context of STEMI treatment?

A

Door-in door-out

It refers to the acceptable timeframe for diagnosing and transferring a STEMI patient from a non-PCI capable hospital.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the contraindications for initiating beta-blocker therapy in STEMI patients?

A

Signs of heart failure, low-output state, increased risk for cardiogenic shock, PR interval > 0.24 seconds, second- or third-degree heart block, active asthma, severe reactive airway disease

Risk factors for cardiogenic shock include age > 70 years, SBP < 120 mm Hg, sinus tachycardia > 110 beats/min, and heart rate < 60 beats/min.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the first-line treatment for ongoing ischemic discomfort in STEMI patients?

A

Sublingual nitroglycerin (0.4 mg) every 5 minutes, up to three doses

Intravenous nitroglycerin is also indicated for ongoing ischemic discomfort, hypertension control, and pulmonary edema management.

18
Q

True or False: Nonselective NSAIDs should be continued in STEMI patients.

A

False

Use of nonselective NSAIDs has been associated with increased risks of reinfarction, hypertension, heart failure, and death.

19
Q

What are the main mechanical complications of myocardial infarction?

A
  • Free wall rupture
  • Ventricular septal rupture
  • Papillary muscle rupture

Each complication has specific clinical presentations and treatment protocols.

20
Q

What triad of findings is suggestive of right ventricular infarction?

A

Hypotension, distended neck veins, clear lungs

Clinical RV infarction occurs in approximately 30% of inferior MIs.

21
Q

What is MINOCA?

A

Myocardial infarction with nonobstructive coronary arteries

It occurs when a patient presents with STEMI but has no significant coronary artery stenosis.

22
Q

What is Takotsubo cardiomyopathy?

A

Stress-induced cardiomyopathy characterized by chest pain, ST-segment elevation, and left ventricular dysfunction

It most commonly affects older women and is often precipitated by emotional stress.

23
Q

What findings suggest pericarditis following myocardial infarction?

A
  • Pleuritic pain
  • Positional pain
  • Pain radiating to the trapezius ridge
  • Audible friction rub
  • Diffuse ST-segment elevation

Treatment usually involves high-dose aspirin and colchicine.

24
Q

What is Dressler’s syndrome?

A

Pericarditis occurring weeks after myocardial infarction, often with fever and malaise

It may be immune-mediated and is treated with high-dose aspirin.

25
Q

Should a prophylactic ICD be implanted in STEMI patients with depressed ejection fraction before discharge?

A

Generally no

Ejection fraction should be reevaluated 40 or more days after discharge due to potential improvement.

26
Q

What long-term therapies are recommended for patients with STEMI?

A
  • Beta-blockers
  • ACE inhibitors
  • Aldosterone antagonists
  • High-intensity statins
  • Aspirin

Specific medications are recommended based on ejection fraction and patient symptoms.

27
Q

How long should patients with STEMI be treated with dual antiplatelet therapy?

A

At least 12 months unless at high risk of bleeding, in which case it can be discontinued after 6 months

Continuation beyond 12 months may be reasonable for those not at high risk.

28
Q

What is the recommended duration of dual antiplatelet therapy (DAPT) for patients with significant overt bleeding?

A

> 12 months may be reasonable

This recommendation is based on clinical considerations in managing patients at risk of bleeding.

29
Q

What does DAPT stand for?

A

Dual antiplatelet therapy

DAPT typically involves the use of aspirin and a P2Y12 inhibitor.

30
Q

What are the two types of acute coronary syndrome (ACS) mentioned?

A
  • Non–ST-segment elevation acute coronary syndrome (NSTE-ACS)
  • ST-segment elevation myocardial infarction (STEMI)

These classifications help guide treatment strategies.

31
Q

What is the primary concern with triple therapy in patients requiring oral anticoagulation (OAC)?

A

Increased risk of bleeding

Triple therapy combines DAPT with an oral anticoagulant.

32
Q

What did the WOEST trial conclude regarding double therapy?

A

Double therapy (clopidogrel and vitamin K antagonist [VKA]) reduced bleeding complications without significant increase in thrombotic events compared to triple therapy.

This trial is pivotal in determining the safety of antithrombotic regimens.

33
Q

What advantage do direct oral anticoagulants (DOAC) have over vitamin K antagonists (VKA) post-PCI?

A

Decreased bleeding risk

DOACs are preferred in many cases due to their safety profile.

34
Q

What is the preferred P2Y12 inhibitor in patients post-PCI according to the North American consensus statement?

A

Clopidogrel

Ticagrelor may be considered in patients with high ischemic/thrombotic and low bleeding risks.

35
Q

What should be considered immediately after hospital discharge for most patients requiring antithrombotic therapy?

A

Double therapy (OAC plus P2Y12 inhibitor)

This approach balances the risks of bleeding and thrombotic events.

36
Q

What is a key intervention that dramatically reduces the risk of future cardiac events?

A

Smoking cessation

Healthcare professionals often underemphasize the importance of this intervention.

37
Q

What benefits does cardiac rehabilitation provide?

A
  • Increases functional capacity
  • Decreases angina
  • Reduces disability
  • Improves quality of life
  • Modifies coronary risk factors
  • Reduces morbidity and mortality

Referral to a rehabilitation program is recommended for all STEMI patients.

38
Q

What is Dressler’s syndrome and when can it occur?

A

Includes pericarditis and can occur 1 to 8 weeks post-myocardial infarction (MI)

It is an autoimmune response that can develop after heart injury.

39
Q

What is heart failure with reduced ejection fraction (HFrEF) resulting from?

A
  • Pump dysfunction
  • Negative remodeling

It may also arise from mechanical complications like papillary muscle dysfunction.

40
Q

What complications can arise from a left ventricular (LV) thrombus?

A

Occurs most commonly in the first 3 to 6 months post-MI in patients with anteroapical akinesis

Prophylactic OAT may be considered despite the risks associated with triple therapy.

41
Q

What arrhythmia can develop due to myocardial fibrosis and ventricular aneurysm?

A

Ventricular tachycardia

These areas can serve as foci for reentrant circuits.

Cardiology Secrets (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions