CIS Myocardial Infarction (Johnston) Flashcards Preview

Cardiovascular Medicine-Unit 2 > CIS Myocardial Infarction (Johnston) > Flashcards

Flashcards in CIS Myocardial Infarction (Johnston) Deck (33):
1

Sympathetic hyperactivity (increase HR, increase BP) is usually seen in ___ MI

Anterior

2

Parasympathetic activity (bradycardia, decreased BP) is usually seen in ___ MI

Inferior

3

Describe the EKG findings and cardiac enzymes in NSTE ACS:

ST depression, T wave inversion with chest pain

Normal cardiac enzymes

4

When do you see Q waves?

Infarction --> Dead tissue, lacks depolarization

5

What do ST segment shifts (elevation or depression) indicate?

Myocardial injury --> deficient blood supply, inability to fully polarize

6

T wave changes such as T wave inversion indicate __

Ischemia --> deficient blood supply, impaired repolarization

7

Anterior wall infarctions are associated with which artery and which leads?

LAD

V1-V7

8

Inferior wall infarctions (RV infarction) is associated with what artery and which leads?

RCA

II, III, aVF, V3R-V6R

9

Lateral wall infarctions are associated with which artery and what leads?

Circumflex

I, aVL, V5-V6

10

Posterior wall infarctions are associated with which artery and which leads?

Posterior descending artery

V1-V3

11

What leads will you look at for a true posterior infarct and what will they show?

Since no ECG lead reflects posterior electrical forces, changes are reciprocal of those in anterior leads. Lead V1 shows unusually large R wave (reciprocal of posterior Q wave) and upright T wave (reciprocal of posterior T wave inversion)

12

What would you see in the following labs after an MI:

-WBCs:
-CRP:
-BNP:

Increased WBC (hrs to 2-4 days)
Increased CRP
BNP increased in ventricular wall stress and fluid overload

13

The majority of deaths related to AMI occur within 1 hr of onset of symptoms and most deaths are related to ___

V fib

14

What is the E.D. Standard of care for a STEMI?

12 lead ECH with continuous cardiac monitoring
IV lines inserted
Cardiac enzymes (cTnI), CBC, CMP, PT, PTT

15

What do you want to do for reperfusion strategy in STEMI?

Primary percutaneous coronary intervention (PCI) with angioplasty and stunting
Cath lab within 90 mins (goal)

16

When do you ideally want to begin fibrinolysis in STEMI in the ED?

Within 30 minutes

17

Primary PCI is preferred for STEMI with symptoms less than __ hours

12

Lower mortality rate and intracerebral hemorrhage

18

What is a major risk for for fibrinolytic therapy in a STEMI or new left BBB within 12 hrs of onset of symptoms?

Intracerebral hemorrhage

19

What can you give for initial medical management for a STEMI?

Aspirin - given on presentation unless contraindicated

20

This drug can relieve vasoconstriction; relieve pain (chest), reduce pre and afterload

Nitroglycerin

21

When do you not want to give a B blocker for a pt with a STEMI?

Dont use in decompensated HF, decreased HR, decreased BP

22

What can you give to a pt who has acute pericarditis after an MI?

Aspirin
NSAID

23

What sort of rhythm disturbances can occur following an MI?

V fib (Rx elective cardioversion)
Catch
Polymorphic V tach
V flutter

24

This benign arrhythmia can occur following fibrinolytic therapy:

Accelerated idioventricular rhythm (AIVR)

25

Sinus bradycardia is associated with an __ MI (up to 40% pts)

Inferior

26

Second degree AV block Wenckebach is associated with __ MI

Inferior wall

27

____ is the leading cause of hospital death from AMI

Heart failure

28

Acute mitral valve regurgitation can occur following an MI as a complication d/t

Rupture or dysfunction of papillary muscle

29

A new holosystolic murmur is a mechanical complication following an MI associated with a ___ MI

Inferior wall

Need surgery

30

Septal rupture with Ventricular septal defect is associated with an __ MI

Anterior wall

31

LV free wall rupture can cause __

Tamponade

32

LV aneurysm is associated with an __ MI

Anterior

33

Most MIs are caused by this underlying condition:

Atherosclerosis