MI diagnostic studies and Treatment Flashcards
What characterizes ST elevation?
Definition: > 0.1 mv
Inferior MI characterizations
On ECG elevations in II, III and aVF
Posterior MI characterizations
On ECG elevations in leads V1 and V2
Anteroseptal MI characterizations
On ECG Leads V1 and V2
Anterior MI characterizations
On ECG V1, V2 and V3
Anteriolateral MI characterizations
On ECG V4, V5, V6
Describe ECG progression of ST elevation MI
peaked T waves to ST segment elevation to Q waves to T wave inversion
Describe CXR progression of CHF
- Stage 1 CHF-
- redistribution of pulmonary vessles (13-18 mm Hg)
- Cardiomegaly
- Broad vascular pedicle
- Stage 2
- Interstitial edema (18-25 mm Hg)
- Kerley B lines
- Peribronchial cuffing
- Hazy contour of vessles
- Thickened interlobular fissure
- Stage 3
- Alveolar edema (> 25 mmHg)
- Consolidation
- Air bronchogram
- Cottonwool appearance
- Pleural effusion
Cardiac Echo
Transthoracic vs Tranesophageal echo
Pre-Hospital treatment of MI
* 50% of deaths from MI occur before the pt reaches the hospital
- Aspirin 81 mg x 2= 162 mg or 325 mg immediately
- Clopidogrel (Plavix) 300 mg given once as loading dose
* Titrate down to clopidogrel 75 mg/day - Vasodilator- to help relieve ischemic pain
* Nitroglycerin - Morphine for pain control if Nitro not effective
- Enoxaparin (better than heparin) significant reduction in death and MI at day 30
Thrombolytic therapy for MI
- Most effective in 1st 3 hours. (50% reduction in mortality)
* Pts should be treated up until 12 hours after onset of symptoms (10% reduction in mortality) - ST elevation- suggests ascute coronary occlusion- warranting reperfusion
- Streptokinase no longer avail in US
- Tissue plasminogen activator (t-PA)
What are contrinidations to using tissue plasminogen activator t-PA?
- Stroke within one year
- Intercranial neoplasm
- Recent Head trauma
- Active internal bleeding
- Concern for aortic dissection
What are relative contraindications for tissue plasminogen activator t-PA?
- Blood ressure > 180/110
- IntrAcerebral pathology
- Trauma within 2 weeks
- Major surgery in the past 3 weeks
- CPR lasting more than 10 minutes
- Pregnancy
- Current use of anti-coagulants
When do you performe PCI percutaneous coronary intervention?
Catherization and stenting has been shown to be better than thrombolytic therapy when performed by experienced people and in a high volume center
- Door to balloon time < 90 min
If PCI is not a viable option may have to progress to this procedure for MI
CABG Coronary artery bypass grafting
