3-1: 9/8: Complications Of Mi

Front 1

LAD runs along the [back/front] of heart.

Back 1

Front of heart

Front 2

Events of the Acute MI/Ischemic Cascade (in order)

Back 2

1) Diastolic Dysfn
2) Regional Systolic Dysfn (ex: if occluded LAD, would only get dysfn in anterior region of heat)
3. Ischemic EKG Changes
4. Chest pressure (pain)
5. Release of CPK, troponin

Front 3

How long does ischemia have to occu to induce irreversible cell injury?

Back 3

20-30 minutes

Front 4

24 hours after MI, you can expect to see ________.

Back 4

Coagulation necrosis

Front 5

5-7 dyas after MI, you can expect to see _________.

Back 5

Yellow Softening

Front 6

Ventricular remodeling occurs _________ weeks after MI.

Back 6

1-4 weeks

Front 7

Fibrosis is completed _________ weeks after MI.

Back 7

6-8 weeks (no longer have soft heart muscle)

Front 8

This main coronary artery supplied 2/3 of the myocardium.

Back 8

Left main coronary artery

Front 9

This artery supplies the 40% of the LV, the apex, septum, and anterior wall.

Back 9

Left Anterior Descending Coronary Artery

Front 10

This artery supplies all of the right ventricular myocardium and some of the left ventricular myocardium.

Back 10

Right Coronary Artery

Front 11

Yellow softening of the heart occurs _______ after MI.

Back 11

5-7 days

Front 12

Ventricular remodeling of the heart occurs ________ after MI.

Back 12

1-4 weeks

Front 13

Fibrosis is completed _______ after MI.

Back 13

6-8 weeks

Front 14

This vessel supplies 2/3 of the myocardium.

Back 14

Left Main Coronary Artery

Front 15

This vessel supplies 40% of the LV, including the apex, septum, and anterior wall.

Back 15

Left Anterior Descending Coronary Artery

Front 16

This vessel supplies less LV myocardium, but all of the RV myocardium.

Back 16

Right Coronary Artery

Front 17

This vessel supplies the majority of the ventricular septum.

Back 17

Left Anterior Descending Coronary Artery

Front 18

This vessel supplies blood to the AV and SA nodes.

Back 18

Right Coronary Artery

Front 19

This vessel supplies most of the conduction system below the AV node, i.e., the His-Purkinje System.

Back 19

Left Anterior Descending

Front 20

Occluded LAD may result in ______________.

Back 20

LV failure
High grade heart block
Apical aneurysm
Thromboembolic complications

Front 21

Occluded RCA may result in _____________.

Back 21

RV failure
Bradycardia

Front 22

Sinus bradycardia can be due to an infarct of _______.

Back 22

Inferior myocardium

Front 23

Sinus tachycardia can be due to an infarct of _______.

Back 23

Anterior myocardium (big decrease in heart volume)

Front 24

Atrial fibrillation is due to dilation of the __________.

Back 24

LA dilation, acute LV failure

Front 25

Inferior MI:
Cardiac Signs

Back 25

Sinus bradycardia (SA nodal artery and increased vagal tone)

Heart Block: AV nodal artery

A fib—LA stretch

V tach/fibrillation via reentry or inc’d automaticity

Front 26

Anterior MI:
Cardiac Signs

Back 26

Sinus tachycardia—in response low stroke volume

Heart Block: His-purkinje system (RBBB, LBBB, complete heart block)

V tach/fibrillation due to reentry or inc’d automaticity

Front 27

Diastolic and systolic dysfunction can both lead to __________.

Back 27

Increased LVEDPPulmonary CongestionCongestive Heart Failure

Front 28

Papillary Muscle Rupture:
Cardiac Consequences
Treatment

Back 28

Leads to acute mitral regurgitation
Systolic murmur
Giant V waves
Treat with afterload reduction (anything that dilates arterial system, like ACE-inhibitor, hydralazine)

Inotropic support (DA, dobutamine)

Intra-aortic balloon bump

Front 29

Acute Ventricular Septal Defect:
Associated MI
Cardiac Signs
Treatment

Back 29

Due to either anterior or inferior MI

Causes abrupt left-to-right shunt

Grade IV murmur with thrill with O2 saturation step-up (O2 saturation in right heart usually around 75%; RV sat >> RA sat)

Tx:
Afterload reduction
Inotropic Support
Intra-aortic balloon pump

Front 30

Function of intra-aortic balloon pump?

Back 30

Augments coronary blood flow during diastole

Decreases afterload during systole by deflating at onset of systole

Front 31

Free Wall Rupture:
Cardiac Consequences

Back 31

Cardiac tamponade
Pseudoaneurysm

Front 32

Apical Aneurysm:
Associated MI
Cardiac Consequences

Back 32

Large, transmural antero-apical MI
Can lead to LV apical thrombus
Associated with ventricular arrhythmias
Causes dyskinesis of apex

Tx:
Coumadin to prevent embolization

Front 33

Right Heart Failure:
Causes
Presentation
Treatment

Back 33

Sequela of L heart failure
Could be due to RV infarct (occlusion of RCA)

Presentation:
JVD with clear lungs (RA pressure is elevated)
ST elevation in right precordial leads

Tx:
Fluids!

Front 34

Cardiogenic Shock:
Cause
Treatment

Back 34

Usually due to large area of myocardial necrosis
Tx: rapid reperfusion (stent), intraaortic balloon pump, inotropic drugs

Front 35

Back 35