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32 Cards in this Set

  • Front
  • Back
Most common cause of acute MI
Destabilization of atherosclerotic plaque with subsequent thrombus formation
Name 2 causes of acute MI where thrombolytic therapy is contraindicated
Embolic phenomenon
Thoracic aortic dissection
3 " big factors" in diagnosis of acute MI
Serum cardiac markers

Dont need to meet all 3 - can meet just two - dont need to wait for cardiac markers
Detects MI as a “hot spot” on the nuclear scan between 24 hours and 5 days after symptom onset – not useful in acute setting
99mTc-pyrophosphate scan
Positive scan (a “hot spot” on the nuclear scan) may be seen in:
Acute MI
Unstable angina pectoris
Active myocarditis
Cardiac transplantation rejection
111In-antimyosin scan
Differential diagnosis of chest discomfort - CARDIOVASCULAR
-Acute MI
-Unstable angina
-Prinzmetal’s (variant) angina
-Acute pericarditis
-Valvular heart disease (AS, MVP, MS)
-Hypertrophic cardiomyopathy
-Thoracic aortic dissection
-Myocarditis (occasionally)
Patient presents with jabbing sensation in chest, gets better on sitting up, worse when taking a breath - diagnosis
Acute pericarditis
Differential diagnosis of chest discomfort - PULMONARY
-Pumonary embolism (PE)
-Pleuritis (pleurisy)
-Severe pulmonary hypertension
Differential diagnosis of chest discomfort _ GI
-Esophageal spasm
-Peptic ulcer disease (PUD)
-Biliary colic (cholecystitis, etc.)
-Mallory-Weiss syndrome - tear from excessive vomitting (alcoholics)
Differential diagnosis of chest discomfort - Musckuloskeletal
-Tietze syndrome:Tenderness and swelling of the costal cartilage
-Somatic dysfunction
-Chest or upper extremity trauma
-Thoracic outlet syndrome – 1st rib dysfunction
Differential diagnosis of chest discomfort - Neurological
-Herpes zoster
-Intercostal neuralgia
How do you decrease myocardial oxygen demand
-Bed rest
-NPO until stable
-Double product Beta blockade (unless contraindicated)
Other antihypertensives (if BP is elevated)
Avoid agents known to cause reflex tachycardia
Digoxin - may be of value for tachycardia associated with hypotension or CHF
How do you increase myocardial oxygen supply
-Supplemental O2
-Relieve pulmonary vascular congestion (if present)
-Diuretics, IV NTG, MSO4
-Acute revascularization
-Thrombolytic therapy
Standard of care (in hospitals without primary PCI capability)
-Mechanical revascularization
-Catheter-based intervention
-CABG surgery
-Intra-aortic balloon pump (IABP)-If cardiogenic shock and if cath lab available
Benefits of using thrombolytic therapy
-Lyses occlusive coronary thrombus rapidly
-Improves LV function
-Reduces both short-term and long-term mortality
Risks of thrombolytic therapy
-Anaphylaxis (SK and APSAC)
-Arrhythmia (reperfusion)
Time frame for most beneficial use of thrombolytics
Less than 6 hours from onset
Less beneficial but still worthwile use of thrombolytic therapy - time frame
6-12 hours from onset
Time frame when thrombolytic therapy gives little apparent benefit unless there is ongoing chest discomfort or a “stuttering” course
Over 12 hours from onset
EKG criteria for acute MI
-ST segment elevation > 1 mm in 2 or more contiguous precordial or limb leads
-New (or presumed new) LBBB
-ST segment depression with prominent R waves in leads V1 and V2, if this is thought to represent a posterior wall infarction rather than unstable angina
Which therapy is standard of care in patients with MI
Name contraindications for thrombolytic therapy
-Any prior intracranial hemorrhage
-Known structural cerebral vascular lesion (e.g., arteriovenous malformation)
-Known malignant intracranial neoplasm (primary or metastatic)
-Ischemic stroke within 3 months (except acute ischemic stroke within 3 hours)
-Significant closed-head or facial trauma within 3 months
-Suspected aortic dissection
-Active bleeding or bleeding diathesis – problem with coagulation (excluding menses)
Indications for catheter based intervention
-Patients at high risk for thrombolytic therapy
-Cardiogenic shock
Indications for CABG
-Patients with CAD which is not amenable to catheter-based revascularization
-Patients with mechanical complications of acute MI
IV nitroglycerin should be avoided in _
Right ventricular infarctions
Medications to avoid unless a clear-cut indication exists in a patient with aMI
-Calcium channel blockers
-IV magnesium
Mechanical complications of MI
Acute mitral regurgitation
Ventricular septal rupture
Ventricular pseudoaneurysm
Ventricular free wall rupture
Most mechanical complications of MI can be diagnosed by _
Most mechanical complications of MI can be treated by _
IABP insertion followed by emergent open-heart surgery
Peak incidence of mechanical complications of MI
3-5 days
Patient with MI + a. fib.flutter - management?
-Electrical cardioversion if patient is unstable
-Otherwise, control ventricular rate with medical therapy (beta-bockade, digoxin) and anticoagulate.
Patient with MI + V fib/V tach - do you need to do EPS
Generally, EPS is not indicated if V. tach. or V. fib. occurs within 48 hours of acute MI.
Treatment for patient with MI +
-Sinus bradycardia
-AV block
-Observation only
-Temporary pacemaker (external or transvenous)
-Permanent cardiac pacemaker