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Flashcards in 11 - MI Deck (13)
1

classic presentation of MI

crushing retrosternal chest pain with pain shooting down L arm and jaw and diaphoresis

2

what is more common in elderly Sx

- no pain or diaphoresis
- syncope, stroke, acute confusion

3

parts of Phx for MI

- appearance
- vitals
- JVP
- auscultation
- cardiac exam
- peripheral pulses

4

3 early and subtle ECG changes in actue MI

1. increase in R wave voltage in precordials
2. hyperacute T wases in precordials
- symmetric and prominents
3. ST elevation

5

what is worse prognosis on ECG

higher ST elevation and more leads involved

6

investigations

1. CXR only a priority for ruling out dissection
2. trops, but don't rise for 2-6 hours
- serial trops

7

6 complications of acute MI

1. arrhythmias
2. conduction disturbances
3. LV pump failure
4. mech. defects
5. thromboembolism
6. pericarditis

8

**4 Tx priorities in STEMIs

1. ASA
2. thrombolysis or PCI
3. LMWH
4. clopidagrel

9

steps to mgmt of MI

1. stabilize
- O2
2. pharma
- ASA
- nitro, except in inferior MI
3. reperfusion therapy - thrombolysis or PCI
4. heparin
5. BB
6. clopidogreal

10

contraindications to TPA

- recent major surgery or active bleed
- Hx of hem. strokes
- severe uncontrolled HTN
- intracranial neoplams
- suspect aortic dissection

11

preferred thrombolytic therapy

PCI

12

2 recommendations for PCI

1. should get in 90minutes
2. if can't get within 90 minutes then give fibrinolytic therapy

13

4 adv. of LMWH over heparin

1. more predictable anti-coag
2. no need to monitor PTT
3. lower rates of thrombocytopenia
4. better bioavailablilty