EXAM #2: COMPLICATIONS OF MI Flashcards
(34 cards)
When are arrhythmias most common in the setting of MI?
Acute phase b/c of ischemia
Do PVCs require specific management in the post-MI setting?
No
What is an accelerated idioventricular rhythm?
Ventricular rhythm with a rate of 60-110 caused by ischemia induced automaticity of purkinje fibers
*Most often seen post-cath. and an indication of reperfusion
What kind of VT is associated with ischemia and how does this differ from VT associated with a post-MI scar?
Ischemia= Polymorphic
Scar= Monomorphic
What is the treatment for VT?
1) Immediate cardioversion
2) Amiodarone
Late VT/VF occurring 48 hours post-MI is associated with _____?
Increased risk of sudden cardiac death
What are the two indications for sudden cardiac death prophylaxis post-MI?
1) Late VT/VF
2) EF less than 35%
What causes sinus bradycardia in the acute phase of a MI?
1) Sinus node ischemia
2) High PNS tone
- Associated with inferior wall MI
When an inferior MI causes a heart block, what level of the conduction pathway is being most affected? Is a permanent pacemaker required?
AV node
Typically, a permanent pacemaker is NOT required b/c this is due to high vagal tone that is TRANSIENT
How does an anterior MI leading to heart block differ from inferior?
Anterior is:
1) Below the AV node
2) Requires permanent pacemaker
*Also much more rare
What is the difference between Killip class 2 and 3?
Class 2= mild pulmonary edema
Class 3= fulminant pulmonary edema
What is the difference between acute and chronic phase MI associated HF?
Acute= diastolic and/or systolic dysfunction
Chronic= systolic dysfunction
How is HF managed in the acute phase of a MI?
1) Vasodilator i.e. NTG
2) Judicious morphine
3) BiPap
How is HF managed in the post-acute phase of a MI?
1) Diuretic
2) ACE-inhibitors
3) Aldosterone antagonists
*In contrast to the acute phase, these patients are retaining fluid
What is a cardioembolism? What is this most commonly associated with?
- Anterior wall dysfunction leads to emboli formation
- Embolism is a cause of “cardioembolic stroke”
*Note that these can embolize to other locations as well e.g. bowels, legs…etc.
How are cardioembolisms treated?
Anticoagulation with warfarin
When is percarditis typically seen post-MI?
Early= within the first week
- Focal inflammation of pericardium overlying the involved myocardium
Late= 1-8 weeks
What is the treatment for early pericarditis? What treatments must be AVOIDED?
1) ASA
2) Colchicine as an adjunct
*Avoid NSAIDs and sterodis
What is Dressler’s Syndrome?
- Autoimmune disease
- Autoantibodies against the percardium
- Associated with malaise, arthralgias, pleural/ pericardial effusion
What labs are associated with Dressler’s Syndrome?
High ESR and CRP
What increases the risk of an Acute VSD post-MI?
1) Delayed or absent reperfusion
2) Elderly
3) Female
4) HTN
5) First MI
List the sx. of an Acute VSD s/p MI.
Chest pain
Dyspnea
Hypotension
Biventricular failure
What are the PE findings associated with an Acute VSD?
- New murmur
- Left low sternal border
- Thrill in 1/2 of patients
How is an Acute VSD diagnosed?
1) Echo*
2) Right heart catheterization
*Gold standard
