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Gen Med Unit 7: Cardio > STEMI > Flashcards

STEMI Flashcards

1
Q

When do you suspect a cocaine-induced STEMI?

A

Should be considered in young pts w/out risk factors

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2
Q

What is immediately warranted with ST elevation?

A

Immediate re-perfusion therapy

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3
Q

What is the most common cause of a STEMI?

A

STEMI most often results from an occlusive coronary thrombus at site of atherosclerotic plaque rupture

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4
Q

What are the sxs of a STEMI?

A 
1. Sudden onset of prolonged (> 20 mins) anterior chest discomfort w/referred pain
A. Pain, gas, pressure
2. Most occur in early morning
3. Pain > angina
4. NTG has little effect on pain
5. Profuse diaphoresis
6. Weakness
7. Apprehension
8. SOB
9. Lightheadedness 
10. Nausea/vomiting
11. Sudden death & early vent arrhythmias
12. Pt may appear anxious  
13. Diaphoretic
14. Bradycardic to tachycardic
15. Hypertensive to hypotensive
16. Resp distress: if co-existing HF
17. S3 gallop: indicates LV dysfunction
18. Mitral regurgitation murmur if rupture of papillary muscle
19. Cyanosis and cold extremities indicate low CO
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5
Q

What are the diagnostic studies for a STEMI?

A
  1. CK MB
  2. Trop I and T
  3. EKG
  4. CXR
  5. Bedside ECHO
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6
Q

What are the general EKG findings in a STEMI?

A
  1. ST segment elevation
    A. Evolution of EKG normally is peaked T waves –> ST Elevation –> Q wave –> T wave inversion
    B. New LBBB in pts with sx’s suggestive of MI is considered “STEMI” equivalent
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7
Q

What EKG changes may be seen within minutes of the onset of a STEMI? What does this correlate to in the heart muscle?

A
  1. hyperacute T waves (tall T waves), ST-elevation

2. reversible ischemic damage

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8
Q

What EKG changes may be seen within hours of the onset of a STEMI? What does this correlate to in the heart muscle?

A
  1. ST-elevation, with terminal negative T waves, negative T waves (these can last for days to months)
  2. onset of myocardial necrosis
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9
Q

What EKG changes may be seen within days of the onset of a STEMI? What does this correlate to in the heart muscle?

A
  1. Pathologic Q waves

2. Scar formation

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10
Q

What does a bedside ECHO assess? What are the results in a STEMI?

A
  1. Assess LV global & regional function

2. Normal wall motion makes MI unlikely

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11
Q

What antiplt therapy is given for a STEMI?

A
  1. ASA 162-325 mg chewable
  2. Clopidogrel (Plavix)
    300 mg PO loading dose, then 75 mg PO qd x 9-12 months
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12
Q

True/False: both NSTEMIs and STEMIs get reperfusion therapy

A

False: All STEMI’s

Not for NSTEMIs: No benefit from immediate reperfusion and may actually cause harm

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13
Q

What is the timeline for the greatest benefit from reperfusion therapy? What is the alternative if not available?

A
  1. Within 12 hours of onset of sx’s
  2. Door to balloon time < 90 mins
  3. PCI with stenting – preferred if available
  4. Thrombolytic therapy if PCI not available
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14
Q

What coagulants are used when stenting?

A
  1. Abciximab (Reopro)

2. Bivalrudin (Angiomax)

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15
Q

What is the moa of Abciximab (Reopro)?

A

Binds to platelet glycoprotein IIb/IIIa receptors → ↓ platelet aggregation

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16
Q

What is the moa of Bivalrudin (Angiomax) ?

A
  1. Direct thrombin inhibitor

2. Slightly decreased rates of thrombotic events with 40% less bleeding

17
Q

When is the greatest benefit for thrombolytic tx?

A

3 hrs (max 12 hrs)

18
Q

What are the contraindications for thrombolytics?

A
  1. Previous hemorrhagic stroke
  2. Embolic strokes w/in 1 yr
  3. Intracranial neoplasm
  4. Recent head trauma
  5. Active internal bleeding
  6. Suspected aortic dissection
19
Q

What are the risks and risk factors for tpa?

A
  1. Most serious risk is intracranial hemorrhage
  2. Age > 65 yrs
  3. HTN, esp >180/110
  4. Low body weight
20
Q

What are the general treatment measures for a STEMI?

A
  1. CCU monitoring
  2. Bed rest x 24 hrs
  3. Progressive ambulation over next 24-72 hrs
  4. Low flow oxygen to maintain SaO2 ≥ 95%
    A. Usually 2-4 l via NC
  5. Analgesia
    A. SL NTG, IV morphine
21
Q

What treatments are given to STEMI pts before leaving the hospital

A
  1. Beta blockers
  2. Nitrates
  3. ACEi
  4. Morphine
  5. Long Term antithrombotic Therapy
  6. Statin Therapy
22
Q

Why are statins given?

A

Control lipids, reduce incidence of reoccurence

23
Q

What are the long term antithrombotic therapies given to a STEMI pt?

A

ASA 81-325 mg daily

Clopidogrel (Plavix) 75 mg po daily 6-12 mo

24
Q

When is morphine indicated for a STEMI pt?

A
  1. 2-4 mg IV q 5-15 min

2. Use if pain not relieved with NTG

25
Why are ACEi used for STEMI pts?
1. Short & long term benefits 2. Reduce cardiac preload and afterload 3. Benefits greatest in A. Pts with EF < 40% B. Large infarctions C. Heart failure
26
When and why are beta blockers given?
1. Start orally immediately after AMI 2. ↓ Myocardial oxygen demand 3. IV route can cause cardiogenic shock
27
When and why are nitrates given?
1. Agent of choice for recurrent pain 2. Reduces ventricular preload 3. Avoid if ED meds taken 24-48 hrs prior 4. Caution if hypotensive & IWMI
28
What are the most common complications after a STEMI?
``` 1. Post-infarction ischemia A. Maximize medical therapy 2. Arrhythmias A. Very common, including sinus brady, SVT, ventricular arrhythmias, conduction disturbances 3. LV failure 4. Hypotension & shock ```
29
What is the leading cause of death in 1st 24 hr post MI period?
Arrhythmias
30
What can cause sinus brady in MI pts?
Common in IWMI or may be precipitated by beta blockers
31
What can cause a fib in MI pts? How is it treated?
1. May be secondary to electrolyte disturbances or hypoxia | 2. Treat with IV beta blocker, IV CCB, IV digoxin or cardioversion
32
When are ventricular arrhythmias most likely? How are they managed?
``` 1. V Tach A. Treat with IV bolus lidocaine, then qtts (stable) B. Cardioversion (unstable) 2. V Fib A. Defibrillate B. Amiodarone IV ```
33
How is first degree AV block treated?
Very common, NO Tx needed
34
How is second degree AV block treated?
Tx only if bradycardia & symptomatic
35
How is third degree AV block treated? When may it occur?
``` 1. May occur in IWMI A. May resolve spontaneously or take weeks to resolve B. Temporary pacemaker may be required 1. May occur with AWMI A. May require permanent pacemaker ```
36
What are the sxs of acute LV failure?
1. Dyspnea 2. Diffuse rales 3. Hypoxemia
37
How is acute LV failure treated?
1. IV diuretics (furosemide/Lasix) usually first line agent | 2. ACEI (ARB if can’t tol)
38
How is cardiogenic shock post MI treated?
IV fluids | Vasopressors: Dopamine/dobutamine
39
What are the treatment goals after 24 hours post MI?
1. Prevent recurrent ischemia 2. Improve infarct healing 3. Prevent ventricular remodeling 4. Prevent vascular events

Gen Med Unit 7: Cardio (13 decks)

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