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26 Cards in this Set
- Front
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initiating event of MI
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spont rupture of fibrous cap exposure to collagen and activ of plateles
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initial Tx of MI
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ER- asp, morphine, oxygen
if recent onset of pain- try nitro if not going to give thrombol-- give betablok- metoprolol ( will impr surv in MI with ST elev) alternative to coronay thrombopl- immediate angioplasty |
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decision to use thrombol
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physical exam( to exlude the recent traima)
history and ECG with ST elevation-- just this to apply the thrombolytic therapy |
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establish the prognosis
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1 do physical- if big MI - you could see rales or pulm edema
2 age above 70\ prev MI atrial fib anter infarction hypotension sinus tachy female gender DM long term prognosis- related to LV function and amount of residual myocardium that is ischemic and is a risk for future injury |
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atrial fib what could cause it
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HTN
thyreotoxicosis valvular heart dises WPW binge alcohol drinking( holiday heart) |
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firststep in Tx of Afib
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1 step i rate control,
2 conversion to normal rhtm |
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drugs hatblockAV noce and control the ventrical rate
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digox,
beta bl. CCB ( verapam or diltiaz) but not dyhydropyridine |
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when to give digox in Atr fibr
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it is better in heart failure
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when Betablok are indicated after ATr fibr
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1when it is myocard ishemia( read damage)
2 in postoperative period 3CHF $ hyperthyreodism |
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when to cardioverse
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have to be on walfarin befor
and after cardioversion( it is risk here for embolism) if patiens is having A fib more then 2dyas- do--transesoph search for the evidence of thrombi if no thromb- convert by cardioversion and give walfarine fo 6 weeks after-echocardiogram |
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A fibril and hemodynamic compro what to do
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A fib and hemodym comprom-- shck or PE--- do immediate cardioversion
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NYHA give classific
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class 1- no symptms but known heard disease
class2symptoms with strenuous exers class3symptoms with light exer class 4- symp at rest this class is usefull for Tx of heart failure |
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tx of P with heart failure
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ACEIs startfor all with LV disf even without symtms
digoxin- no surv benefits beta blok-must started at low dose-inhibit the symp stimul, incre surv |
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digitals toxicity
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nausea visual pr, lethargy
lightheadeness tx0 Digibind not dialysis- because- too large distrib in blood volume of digs... electrolyte abnor-- hypokalemia hypomagnesimia-- replace!! amiodaron, verapamil,macrolids sprironolact- ==== increase level of digs |
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how to evaluate p with HF before operation
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if it is new HF:
1..>>screen for CAD 2..>> if no Q waves>>> stress perfusion 3if it as initial evaluation- dont repeat- no need check electrolytes and water after operation |
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WPW
manag . what is contraindic for TX |
-interm SVT withshort PR interval( < 0.12)and delta vawe
management- 1- if no prev history and symptoms-- reassur 2 if bother- do catheteris tx withdogoxin and verapamil contraindicit coul promoteantergared accec pathway conduction avoid drugs or maneuver that could block AV conduction when there is atr fibrlas blocking AV node can promote unusually rapid conduction through accessory pathway adenosi, beta blockers and valsalva may help some time |
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risk of ruprure of AAA
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5cm- 25%- 6 -36 % risk of rupture for 5 years period
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risk of AAA repair
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if P had AAA- he has CAD in35% even in the absence of symptoms
mortality is very high- up to 70% |
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syptomatic AAA
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they are tender
and carries the big risk for rupture 1/3 of symptoimatic AAA will rupture in 1 month and 2/3 of AAa will rupture within 6 m most symtom AAa will rupture within 1 year- the maximum diameter is not primary determinate of rupture for symptomatic AAA |
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VARIANT ANGINA TX
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the final step in variant angina- increasing the Ca in smooth wall of art
therapy- CCB, they inhibit the influx of CA nitro could be usefull too No beta blockers- may increase vagosp, because of unopposed alfa adrenergis ctimulation--- coronary vasospam vasospasm could be seen in P, started antiHTN Rx with betablokers recently. |
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why we don;t perform surgical Tx of vasospasm
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surgery is dont on tightateroscl lesion, vasospa isnot tight, spastic arteries aretent to be touche and will develop intense spasm at the time of surgical manipulation
postoperative ST segment elevation, arrhythmia and MI may follow |
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why aspirin could be given with precaution to P with vasospasm
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aspirin inhibit the production of
prostacycine--( coronary vasodilator and this could lead to vasospasm |
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what could precipitate the coronary spasm
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cocaine ( inhibit the reuptake of NE by sympathetic nerve ending that lead to casocobnstr).. this is common cas of MI in normal arteris
hyperventilation, ,, in this conditin will be vasospasm,,( respiratory alkalosis) vasospasm requires the availability of CA ions, hydrogen compete withh ca iones, if hydrogen falls- will be more Ca>> vasospasm Mg lower the available CA ion concentration and correction of hypoMg will reserve spasm in P with resistant variant angina pheochromocytoma-- patchy necrosis-secondary to vasospasm |
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p had new murmur after MI( 3 days ago), rales, JVD. murmur radiate to axilla
what could be the explanation for murmur |
acute rupture of IV septum-- VSDmay give thrill
degree of pulmonary edema may be worse with MI |
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what is diagnostic choice for murmur in P with MY and possible rupture
what to do for definitive ds |
dopler echo
for def diag complete right and left vent cathet |
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wall rupture in septum..
who is prone when |
old women
steroid therapy andlate throm therapy- increase the risk of rupture if long history- of coronary disease will be collaterales and decrease risk of rupture rupture occurs 50 -19 days it is more CCod death after MI, following arrht and heart failure |
