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19 Cards in this Set
- Front
- Back
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cardiac stunning
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reversible process occurring with myocardial ischemia
muscle is reperfused after ischemic event, although there are contraction abnormalities |
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myocardial hibernation
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cells decrease their contractility by shunting blood away to other regions of the heart that need it during decreased o2 delivery
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evolution of ekg changes during stemi
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st elevation
t wave inversion q wave |
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what other ekg finding should indicate an mi
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new lbbb
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how are ck and ck-mb used in mi
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total ck and ck-mb must both be elevated in order to be considered +
they are + before troponins |
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how long does it take for troponins to become + in mi
how long will it stay elevated |
6 hrs
days to weeks |
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other than mi what else can increase troponin levels
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sepsis
burns sah |
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indication for use of thrombolytics in stemi
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must be in stemi (no benefit to use in ua/nstemi)
sx and ekg changes in 2 contig leads (or new onset lbbb) pt must present w/i 12 hrs of becoming symptomatic not have any contraindications to tx |
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absolute contraindications to thrombolytics
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avm
gi bleed brain tumor stroke or neurosurgery within 6 weeks trauma or major surgery within 2 weeks aortic dissection |
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relative contraindications to thrombolytics
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cpr >10 mins
bp >200/110 trauma or major surgeries within 6 weeks pre-existing coagulopathy pud infective endocarditis pregnancy |
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meds commonly used for thrombolysis
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streptokinase
tpa reteplase tenecteplase |
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effects of streptokinase on outcome
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50-60% chance of opening occluded artery
18% decrease in mortality |
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benefits of streptokinase over other thrombolytic agents
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decreased rate of ich
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risks of streptokinase over other thrombolytic agents
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allergic reaction
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benefits to tPA
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more fibrin selective than streptokinase
70-80% chance of making artery patent no allergic reaction |
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risks of tPA
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.7% rate of ich
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benefit of reteplase
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greater patency of arteries at 90 mins post-infusion, but overall 30 day mortality rate unchanged
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benefit of tenecteplase
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can be given as a single bolus
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what must also be given with thrombolytics and why
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heparin or enoxaparin b/c after thrombolytics the body upregulates platelets so pt can re-occlude the artery that was just opened\.
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