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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
Q

Why are ACEi used for STEMI pts?

A
  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
Q

When and why are beta blockers given?

A
  1. Start orally immediately after AMI
  2. ↓ Myocardial oxygen demand
  3. IV route can cause cardiogenic shock
27
Q

When and why are nitrates given?

A
  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
Q

What are the most common complications after a STEMI?

A 
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
Q

What is the leading cause of death in 1st 24 hr post MI period?

A

Arrhythmias

30
Q

What can cause sinus brady in MI pts?

A

Common in IWMI or may be precipitated by beta blockers

31
Q

What can cause a fib in MI pts? How is it treated?

A
  1. May be secondary to electrolyte disturbances or hypoxia

2. Treat with IV beta blocker, IV CCB, IV digoxin or cardioversion

32
Q

When are ventricular arrhythmias most likely? How are they managed?

A 
1. V Tach
A. Treat with IV bolus lidocaine, then qtts (stable)
B. Cardioversion (unstable)
2. V Fib
A. Defibrillate  
B. Amiodarone IV
33
Q

How is first degree AV block treated?

A

Very common, NO Tx needed

34
Q

How is second degree AV block treated?

A

Tx only if bradycardia & symptomatic

35
Q

How is third degree AV block treated? When may it occur?

A 
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
Q

What are the sxs of acute LV failure?

A
  1. Dyspnea
  2. Diffuse rales
  3. Hypoxemia
37
Q

How is acute LV failure treated?

A
  1. IV diuretics (furosemide/Lasix) usually first line agent

2. ACEI (ARB if can’t tol)

38
Q

How is cardiogenic shock post MI treated?

A

IV fluids

Vasopressors: Dopamine/dobutamine

39
Q

What are the treatment goals after 24 hours post MI?

A
  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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