Flashcards in Treatment for acute MI Deck (21):
General therapy for MI
-oxygen >90% CLASS I
Anti-emetic you could give with morphine
When would you not give a beta-blocker?
signs of heart failure,
evidence of a low output state,
increased risk for cardiogenic shock, or
relative contraindications to beta blockade
1AVB > 0.24 sec,
2nd- or 3rd-degree heart block
reactive airway disease
When should you give beta blockers for an MI?
Within the first 24 hours
PCI time window
Within 90 minutes of MEDICAL CONTACT
Fibrinolytic time window
Within 30 min of HOSPITAL PRESENTATION (unless contraindicated)
What kind of bolus of Reteplase would you give?
Contraindications to thrombolysis
Recent surgery, recent trauma or head injury, bleeding diatheses, coma, active peptic ulcer, recent stroke, suspected aortic dissection, traumatic resuscitation attempt, allergy to streptokinase (for streptokinase but alternative can be given) etc. Severe hypertension – control the blood pressure first eg with GTN then proceed.
Thromboylsis and severe high blood pressure?
Control high blood pressure first before you commence with thrombolysis (control with GTN)
Streptokinase side effects
nausea, hypotension, allergy, bleeding, reperfusion arrhythmias
tPA (alteplase) side effects
Bleeding, Reperfusion arrhythmias
Opiate side effects
sedation, hypoventilation, nausea
High flow oxygen side effects
Type II respiratory failure
Beta blocker side effects
bradycardia, cardiac failure, bronchospasm in asthma & chronic bronchitis, hypotension
Treatment for ischaemic VT?
DCCV, cath lab (if needed), electrolyte correction, amiodarone, lidocaine, beta-blockers
Complications of MI
Ventricular Septal Perforation
Ischemic Mitral Regurgitation, Papillary Muscle Rupture
Ventricular Free Wall Rupture
Cardiogenic shock/pulmonary oedema and MI treatment?
MONA - Morphine, Oxygen, Aspirin
No nitrates because hypotensive
No beta-blocker b/c in heart failure
I.V. Inotropic agents:
Dobutamine / Dopamine
Intra-aortic balloon pump
Secondary prevention following MI
-Physical activity for 20-30mins a day
-Mediterranean style diet
-2-4 portions of oily fish per week (if they can't achieve this: 1g of daily omega-3 acid for secondary prevention up to 4 years)
When should aspirin and clopidogrel be prescribed?
-after an NSTEMI
-after PCI and stents
Drug therapy for all when ya are going home
All patients who have had an acute MI should be offered treatment with the following drugs:
-ACE (angiotensin-converting enzyme) inhibitor