Myocardial Infarction - Johnston

Question 1

What are the cardinal signs of CV diseases?

Answer 1

• Chest pain
• Dyspnea, orthopnea, paroxysmal, nocturnal dyspnea, wheezing, cough, hemoptysis
• Fatigue, weakness
• Pain in extremities with exertion

Question 2

ST segment elevation indicates what kind of occlusion?

Answer 2

transmural –> Acute MI

Question 3

What are some causes of MI?

Answer 3

atherosclerosis (most common); other include vasospasm (broken heart syndrome); vasculitis, dissection, genetics

Question 4

What are some cardinal signs of MI?

Answer 4

• chest discomfort, heavy, pressure, crushing etc
• Retrosternal, left, across chest; neck jaw, left arm, epigastrium
• Nausea, vomiting, diaphoresis, dyspnea
• not relieved by nitro or rest

(keep in mind 20% of AMI are painless as seen in diabetics elderly woman)

Question 5

Signs of new heart failure includes _

Answer 5

• S3 gallop
• crackles in lungs
• increased JVD
• new murmur

Question 6

S4 gallop indicates _

Answer 6

atria beating forcefully against a less compliant ventricle as heart after an MI

Question 7

Sympathetic hyperactivity (increased BP and HR) are seen in _ Mi

Answer 7

anterior

Question 8

Parasympathetic hyperactivity (bradycardia, decreased BP) is seen in _ MI

Answer 8

inferior

Question 9

Distinguish between NSTEMI and NSTE ACS

Answer 9

NSTEMI: ST segment depression, T wave inversion, chest pain, elevated cardiac enzymes

NSTE ACS: aka unstable angina; ST segment depression, T wave inversion, chest pain; normal cardiac enzymes

Question 10

In early phase of acute MI what EKG changes are seen ?

Answer 10

• T wave increase amplitude
• hyperacute-pattern
• convex upward ST pattern

Question 11

Besides MI what are some other causes of ST segment elevation?

Answer 11

• Pericarditis
• LVH with J point elevation
• Normal variant early repolarization
• Some blacks normally have ST elevation slightly

Question 12

Persistent ST elevation (after 2 weeks) indicates _

Answer 12

ventricular aneurysm

Question 13

During ischemia how does the T wave appear?

Answer 13

inverted T waves and tall, peaked T waves

Question 14

Fireman’s hat looking QRS think

Answer 14

AMI

Question 15

Significant Q waves and T waves inversion in leads II, III, and AVF indicates

Answer 15

Diaphragmatic or inferior infarct associated with RCA occlusion

Question 16

how would you recognized necrosed tissue after an MI?

Answer 16

NO R wave, just QS wave.

Question 17

HOw can you tell where the Acute MI occurring?

Answer 17

Look for where the T waves are inverted: inferior = 2,3,F; Lateral = 1, L, V5-6
Anterior: V2-6

Question 18

T waves are never normally inverted in which leads?

Answer 18

V2-6. If you see inverted T wave these in these leads think = pathology

Question 19

what are some causes of ST depression?

Answer 19

• Subendocardial ischemia
• Stress test
• Digitalis toxicity

Question 20

Diagnostic features of an MI

Answer 20

• Significant Q waves changes (greater than 1mm in width, and 1/3 normal amplitude)
• STE or ST depression
• Inverted Twaves

Question 21

What is the standard care for STEMI

Answer 21

-EKG and continuous cardiac monitoring
- IV inseted
- Cardiac enzymes, blood panels, clotting times
- reperfursion, fibrinolysis
- heparin,
MONA

Question 22

What are the treatments for ACUTE coronary syndrome?

Answer 22

In acute coronary syndrome use “MONA-B”

• morphine
• oxygen
• nitroglycerin
• aspirin
• ACE-inhibitors
• may also use B-blockers, GPIIb/IIIa antagonists and angioplasty

Question 23

What drugs improve Post-MI mortality rates?

Answer 23

• Aspirin
• B-blockers
• ACE-inhibitors
• ARBs
• HMG-CoA reductase inhibitors (statins)
• NOT calcium channel blockers

Question 24

After an MI patient should be brought to a cath lab within _ minutes

Answer 24

90

Question 25

If cath lab is not available fibrinolysis should begin in ER within _ minutes; or transfer the pt to another facility within _ minutes

Answer 25

- 30 minutes | - transfer within 120

Question 26

Primary PCI are preferred to STEMI with symptoms within _ hours

Answer 26

less than 12

Question 27

How is reperfusion therapy monitored?

Answer 27

EKG. must see resolving ST elevation within 1-2 hours

Question 28

What are some contraindications for fibrinolytic therapy?

Answer 28

- Active bleeding or bleeding diathesis - prior hemorrhagic stroke, ischemic stroke within 3 months - Intracranial or spinal cord neoplasm or arteriovenous malformation - suspected or known aortic dissection - closed head or fascial trauma within 3months

Question 29

What is the initial medical management choice of drug for STEMI/

Answer 29

aspirin - given at presentation or unless contraindicated

Question 30

what are some complications of MI/

Answer 30

- recurrent chest pain - Acute pericarditis (dressler syndrome) - treat with aspirin or other NSAID - rhythm disturbances ( VF, VT, VT polymorphic) - Afib (in 1st 24hr) - Sinus bradycardia (associated with inf wall MI) - 2nd AV block (associated with inferior wall MI) - Acute mitral regurg (rupture of papillary muscle) - New holosystolic murmur (inf MI) - Septal rupture w/ VSD (associated with anterior MI) -- > temponade, LV aneurysm - arterial emboli from LV aneurysm --> stroke, ischemic bowel

Question 31

If a pt with hx of MI treated with fibrinolytic therapy develops ventricular tachycardia , what is this finding called on a EKG?

Answer 31

accelerated idioventricular rhythm (AIVR) - benign

Question 32

What is the leading cause of death from AMI?

Answer 32

heart failure

Question 33

How can you tell if a pt is having an RV infarction?

Answer 33

- decreased BP, clear lungs, increased JVP - jussmaul sign (distension of jugular vein on inspiration) treatment: IV fluids