STEMI Flashcards
troponin I and troponin T remain elevated for
7-10 days after stemi
CK rises within
4-8hrs
ckmb ck ratio suggests MI over skeletal source
> = 2.5
2 serious complications of stemi
SVD and MR
MI classifications
type 1 spontaneous 2 ischemia imbalance 3 death but no cardiac markers 4a secondary to PCI 4b secondary to sten thrombosis 5 related to cabg
most out of gospital deaths from stemis are due to suddent development of
vfib occur during first 24 hr of onset of symptoms over half occur in the first hour
goal time of first medical contact to PCI
<120 mins
mechanism of action of aspirin
rapid inhibition of cyclogenase 1 in the platelets followed by a reductiin of thromboxane a2
door to needle
door to balloon
DN <= 30 mins
DB <= 90 mins
nitrates should be avoided in
BP <90
suspicion of RV infarct (inferior infarct in ecg, elevated JVP, clear lungs, hypotension)
absolute:
PD 5 inhibitor preceding 24 hrs
hypotension due to nitrates can be rapidly reversible by giving
atropine
very effective analgesic for pain in stemi
morphine
morphine can cause vagotonic effect bradycardia and heart block. usually respond to
atropine 0.5mg iv
mechanism of action of fibrinolysis
promote conversion of plasminogen to plasmin lyses firbin thrombi
tPA regimen
15mg bolus
50mg in 30mins
35mg in 60mins
stemi patients activity
bed rest first 6-12 hrs
dangle and sit on bedside chair within 24 hrs
critcare in the first 24 hrs
ambulate 2nd or 3rd day of no s/sx
day 3 increase ambulate (185m (600ft) TID
stemi diet
NPO or clear liquid forst 4-12 hrs fat <= 30% cholesterol <= 300mg/d carbohydrates 50-55% of total calories high in K mg and fiber low in sodium
decreases mortality rate in stemi
aci inhibitors
reduction of LV remodeling after infarct
ARB if intolerant to ACE
antihypertensove not recommended in stemi
Calcium antagonist
primary cause of in hospital death from stemi
most common clinical signs
pump failure
rales
s3
s4
killips classification
I no congestion (MR 5%)
II rales at bases, s3, tachypnea, failure of right side of the heart, venous and hepatic congestion (10-20%)
III pulmonary edema (35-45%)
IV shock with systolic pressure <90, evidence of peripheral vasoconstriction, cyanosis, mental confusion; oliguria (85-95%)
infarction of __% of the LV usually results in cardiogenic shock
40%
signs of RV infarct
JVP distension
kausmaulls sign
hepatomegally
st elevation on R sided leads v4R
R heart cath in RV infarxt
steep right atrial Y descent and an early diadtolic dep and plateau in RV waveforms
risk factors of Vfin in stemi
hypOkalemia (target 4.5)
hypOmagnesemia (2.0)
mgt of PVCs in stemi
no anti arrhythmia drugs (increase mortality rate)
tx betablockers, ready cardioversion and defib
tx of sustained vtach in hemodynamically stable
amiodarone bolus 150mg over 10mins followd ny infusion or procainamide
if no effect
electroversion
unsynchronized 200-300 J
then if still no
epinephrine 1mg iv or 10ml of a 1:10,000 sol or amiodarone bolus 75 to 150mg bolus
slpw ventricular tachycardia
HR 60-100
Accelerated idioventricular rhythn
most common supraventricular tachycardia in MI
sinus tachycardia
treatment of SVT in stemi with no heart failure
beta blockers
verapamil
diltiazem
if no response
persists >2hrs HR 120s
synchronized electrichock 100-200 J monophasic
tx of svt with heart failure
digoxin
pain in trapezius muscle
pericarditis
rx of pericarditis
aspirin 650mg QID
double diffuse displaced apical pulse
LV aneurysm
apical aneurysm
safe sexual activity in stemi
2weeks
return to work after stemi
2-4weeks
