Clinical: 8 Acute MI

Question 1

Describe what Reperfusion Treatment Therapy is

Answer 1

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

Question 2

Relate Fibrinolysis and MI Treatment

Answer 2

• 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

Question 3

What are the Indications for thrombolytic therapy?

Answer 3

• 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

Question 4

What are the Fibrinolysis Contraindications and major risk?

Answer 4

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

Question 5

Describe PCI: post op care

Answer 5

Dual antiplatelet therapy for 12 months, ASA and P2Y12 inhibitor

Question 6

When do you use PCI or Fibrinolytics?

Answer 6

When PCI cannot be done in 120 minutes use FIBRINOLYTICS

Any contraindications for fibrinolytics or cardiogenic shock use PCI

Question 7

Describe an MI Complication AV Block

Answer 7

• 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

Question 8

Describe MI Complications of LBBB

Answer 8

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

Question 9

Describe the uses of Cardiac US and Echocardiography

Answer 9

View for regional or global wall abnormalities

Ischemic muscle - wall motion abnormalities

Question 10

Describe the how Pericarditis relates to MI

Answer 10

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

Question 11

Describe a Right Ventricular Infarct

Answer 11

• 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)

Question 12

What are the pitfalls of ECG?

Answer 12

Diagnostic in 50% of AMI cases

Entirely normal in 20% of AMI cases

Question 13

What are the Q Wave ECG Findings?

Answer 13

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

Question 14

What is the treatment for Post-MI Infarction?

Answer 14

• 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