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Cardio Harrisons > STEMI > Flashcards

STEMI Flashcards

1
Q

troponin I and troponin T remain elevated for

A

7-10 days after stemi

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2
Q

CK rises within

A

4-8hrs

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3
Q

ckmb ck ratio suggests MI over skeletal source

A

> = 2.5

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4
Q

2 serious complications of stemi

A

SVD and MR

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5
Q

MI classifications

A 
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
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6
Q

most out of gospital deaths from stemis are due to suddent development of

A

vfib occur during first 24 hr of onset of symptoms over half occur in the first hour

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7
Q

goal time of first medical contact to PCI

A

<120 mins

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8
Q

mechanism of action of aspirin

A

rapid inhibition of cyclogenase 1 in the platelets followed by a reductiin of thromboxane a2

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9
Q

door to needle

door to balloon

A

DN <= 30 mins

DB <= 90 mins

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10
Q

nitrates should be avoided in

A

BP <90
suspicion of RV infarct (inferior infarct in ecg, elevated JVP, clear lungs, hypotension)

absolute:
PD 5 inhibitor preceding 24 hrs

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11
Q

hypotension due to nitrates can be rapidly reversible by giving

A

atropine

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12
Q

very effective analgesic for pain in stemi

A

morphine

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13
Q

morphine can cause vagotonic effect bradycardia and heart block. usually respond to

A

atropine 0.5mg iv

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14
Q

mechanism of action of fibrinolysis

A

promote conversion of plasminogen to plasmin lyses firbin thrombi

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15
Q

tPA regimen

A

15mg bolus
50mg in 30mins
35mg in 60mins

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16
Q

stemi patients activity

A

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

17
Q

stemi diet

A 
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
18
Q

decreases mortality rate in stemi

A

aci inhibitors
reduction of LV remodeling after infarct
ARB if intolerant to ACE

19
Q

antihypertensove not recommended in stemi

A

Calcium antagonist

20
Q

primary cause of in hospital death from stemi

most common clinical signs

A

pump failure

rales
s3
s4

21
Q

killips classification

A

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%)

22
Q

infarction of __% of the LV usually results in cardiogenic shock

A

40%

23
Q

signs of RV infarct

A

JVP distension
kausmaulls sign
hepatomegally
st elevation on R sided leads v4R

24
Q

R heart cath in RV infarxt

A

steep right atrial Y descent and an early diadtolic dep and plateau in RV waveforms

25
Q

risk factors of Vfin in stemi

A

hypOkalemia (target 4.5)

hypOmagnesemia (2.0)

26
Q

mgt of PVCs in stemi

A

no anti arrhythmia drugs (increase mortality rate)

tx betablockers, ready cardioversion and defib

27
Q

tx of sustained vtach in hemodynamically stable

A

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

28
Q

slpw ventricular tachycardia

HR 60-100

A

Accelerated idioventricular rhythn

29
Q

most common supraventricular tachycardia in MI

A

sinus tachycardia

30
Q

treatment of SVT in stemi with no heart failure

A

beta blockers
verapamil
diltiazem

if no response
persists >2hrs HR 120s

synchronized electrichock 100-200 J monophasic

31
Q

tx of svt with heart failure

A

digoxin

32
Q

pain in trapezius muscle

A

pericarditis

33
Q

rx of pericarditis

A

aspirin 650mg QID

34
Q

double diffuse displaced apical pulse

A

LV aneurysm

apical aneurysm

35
Q

safe sexual activity in stemi

A

2weeks

36
Q

return to work after stemi

A

2-4weeks

Cardio Harrisons (2 decks)

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