CARD 47- Recognition and Treatment of Acute MI Flashcards

1
Q

Describe what Reperfusion Treatment Therapy is

A
  • Tx within 3 hours = 50% reduction in mortality
  • Can treat up to 12 hours after onset
  • Limit infarct size and preserve LV function
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2
Q

Relate Fibrinolysis and MI Treatment

A
  • Administer in less than 30 minutes
  • tPA, TNK, rPA
  • Administer along with ASA and/or P2Y12 Inhibitor and Heparin
  • Only effective in case of a STEMI
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3
Q

What are the Indications for thrombolytic therapy?

A
  • STEMI onset within 12 hours
  • Most effective in 90 minutes
  • ST elevation of at least 1 mm in 2 contiguous leads
  • 2 mm in leads V2 and V3 for men, 1.5 for women
  • New LBBB
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4
Q

What are the Fibrinolysis Contraindications and major risk?

A
  • Intracranial hemorrhage in approximately 1% of patients treated with fibrinolytics for MI
  • Higher risk in patient’s over 75 yo
  • Use PCI instead
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5
Q

Describe PCI: post op care

A

Dual antiplatelet therapy for 12 months, ASA and P2Y12 inhibitor

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6
Q

When do you use PCI or Fibrinolytics?

A

When PCI cannot be done in 120 minutes use FIBRINOLYTICS

Any contraindications for fibrinolytics or cardiogenic shock use PCI

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7
Q

Describe an MI Complication AV Block

A
  • RCA supplies blood flow to the SA and AV nodes
  • Block may be transient and related to vagal tone
  • May respond to atropine since it is at the AV level
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8
Q

Describe MI Complications of LBBB

A
  • Damage to conducting system
  • Presents with new LBBB
  • Clinical symptoms of MI and new LBBB treat as MI
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9
Q

Describe the uses of Cardiac US and Echocardiography

A

View for regional or global wall abnormalities

Ischemic muscle - wall motion abnormalities

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10
Q

Describe the how Pericarditis relates to MI

A
  • Pain decreases with sitting up
  • Dressler Syndrome - post MI syndrome
  • Pericardial and pleural effusions
  • May be inflammatory or immune related with fever and malaise
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11
Q

Describe a Right Ventricular Infarct

A
  • RCA 85%, LCX 15%
  • Fluid back up in systemic circulation
  • Distended neck veins
  • Hypotensive
  • Right sided EKG, elevation RV4
  • IV fluid bolus without NITRATES (AVOID)
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12
Q

What are the pitfalls of ECG?

A

Diagnostic in 50% of AMI cases

Entirely normal in 20% of AMI cases

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13
Q

What are the Q Wave ECG Findings?

A
  • consistent with previous MI
  • Transmural ischemia
  • 1mm wide
  • 1/3 amplitude of R wave
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14
Q

What is the treatment for Post-MI Infarction?

A
  • Lifelong aspirin and/or P2Y12 inhibitor
  • Stent placed - aspirin and P2Y12 inhibitor for a year
  • Beta-blocker within first 24 hours unless contraindicated
  • Lifelong high intensity statin
  • Cardiac rehab program
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