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39 Cards in this Set
- Front
- Back
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What is important to look for on the history when investigating a possible MI?
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-Angina pectoris for a prolonged period of time.
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What are 5 important physical findings on an exam for a possible MI?
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1. S4
2. S3 3. New murmurs 4. Chest findings 5. Neck vein distention |
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What does it tell you if you hear S4/S3?
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That the ventricles are operating at a higher filling pressure.
S3 - an early sign of heart failure S4 - a sign of severe heart failure |
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What would new murmurs possibly indicate?
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There is enlargening of the heart that is pulling on the valves (especially the MITRAL) and causing regurgitation
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What important chest findings can indicate MI?
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Bilateral Crackles/rales in the bases of the lungs
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What would you worry about if you see a drop in BP in acute MI?
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Cardiogenic shock
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What is the first important thing to do in a PE for a possible MI? When?
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EKG WITHIN 10 MINUTES OF ARRIVAL
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Why is the EKG so important?
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It can have very characteristic changes during and after an MI.
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What can an EKG tell us?
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-Q wave vs non-Q wave
-ST segment elevation vs depression -Rythm problems -Transmural infarct or not |
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What is very important about the EKG?
What is the difference between a Q wave and non-Q wave EKG? |
Timing - do it ASAP
Q wave = lots of myocardial loss; most likely transmural Non-q wave = less severe, may be subendocardial |
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What is an additional way to tell if a patient has had an MI?
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Measure cardiac enzymes
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What are 5 treatments for MI early?
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ANABO
-Aspirin -Nitrates -Analgesics -Beta blockers -Oxygen |
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Why aspirin?
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To lyse the thrombosis.
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Why analgesics?
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For pain
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Why nitrates?
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To dilate the veins
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Why b-blockers and oxygen?
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B-blockers to inhibit SNS
Oxygen to fully saturate Hb and make sure there's no carrying capacity loss. |
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What are 2 benefits of treating an MI early?
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-Decreased mortality
-Decreased remodeling of the heart in the long term. |
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What are 2 things you have to treat after an acute MI?
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-The thrombosis
-The plaque |
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How do you treat the thrombosis?
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With lytic therapy:
-intra-coronary -intra-venous |
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What drugs are used in lytic therapy?
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Streptokinase
t-PA |
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What is the drawback of lytic therapy?
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It may get rid of the clot but there is still an underlying ruptured plaque that is susceptible to reocclusion.
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What is a complication of lytic therapy?
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Intracranial bleeds which have 50% mortality
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What are 2 later treatments in acute MI for treating the ruptured plaque?
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-Primary coronary angioplasty
-Angioplasty for failed lytic therapy |
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What is the better late treatment?
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Primary coronary angioplasty
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When should lytic treatment be given during an acute MI?
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asap
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When should angioplasty for failed lytic therapy be given?
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Within 10-15 hours
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When should primary coronary angioplasty (not preceded by lytic therapy) be given?
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Within the first 3 hours!
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what is the success rate of angioplasty treatment for acute MI?
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80-90%
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What mechanical complication following an acute MI has the highest mortality rate?
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Cardiogenic shock
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If a patient with cardiogenic shock due to acute MI comes into the ER, what is the treatment you should immediately give?
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Catheterization - angioplasty; NOT lytic
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What are 5 other mechanical complications of an acute MI?
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-Ventricular septal rupture
-Acute mitral regurgitation -RV myocardial infarction -LV aneurysm -Pseudoaneurysm of the LV |
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What will be a sign of RV MI?
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Increased distention of the IJV neck veins
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What are 5 things that cause death from an acute MI?
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-Bradyarrythmia
-Tachyarrythmia -Conduction system disease -Conduction system blocks |
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What type of infarcts are bradyarrythmia more common in?
What are they due to? |
Inferior wall infarcts
-Due to vagus nerve stimulation |
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What are 2 things that drive tachycardia in acute MI?
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-SNS stimulation
-Increased excitability |
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Why isn't tachycardia such a concern anymore these days?
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Because we give b-blockers to prevent overstimulation of the SNS
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What test allows us to see ventricular tachycardia?
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EKG
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What does Ventricular tachycardia have the potential to go on to become?
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ventricular fibrillation and death
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What is the pathologic mechanism that causes an acute MI?
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Rupture of an atherosclerotic plaque
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