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18 Cards in this Set
- Front
- Back
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Left Ventricular Dysfunction:
-After acute STEMI the left ventricle begins to stretch and .... -Left ventricular size increases, the ventricle changes shape, and the walls begin to .... -This process is called ventricular ..., which precedes the onset of .... -As the heart dilates, the strength of the ventricle weakens and it becomes dynamically impaired. |
dilate
thin remodeling heart failure |
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Left Ventricular Dysfunction:
The normal response of the renin-angiotensin-aldosterone system to a failing heart actually exacerbates cardiac impairment. (retains H20, volume, Na++) At this point, ... and ... become very important therapeutic interventions. ... are also helpful via inhibition of vasoconstriction and promotion of vasodilation. |
ACE inhibitors and ARBs
Nitrates |
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Hemodynamic Assessment:
... is the primary cause of hospital death from acute STEMI. The extent of the infarction size directly relates to the amount of pump failure and mortality. The most common signs are pulmonary rales, S3 and S4 gallop sounds, and tachycardia. |
Pump failure
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Hemodynamic Assessment:
As loss of functional myocardial tissue reaches 40% the patient develops ..., which carries a mortality rate of approximately ...%. The physical signs and symptoms progressively increase with addition of hypotension. |
cardiogenic shock
85 |
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Is PCI indicated in a patient with cardiogenic shock?
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no
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Hemodynamic assessment:
When intracardiac filling pressures -become elevated, use IV ... -drop below normal, carefully administer ... If BP remains low, then adrenergic inotropic drugs like ... must be administered. |
loop diuretics
fluids dopamine |
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Management of Acute STEMI-Induced
Heart Failure: -Treat hypoxemia with .... -Treat volume overload with ... -Maintain cardiac output via afterload reduction using ... and .... -Control cardiac rhythm with .... -Provide ... support with dopamine and dobutamine. -Digitalis is no longer considered helpful in acute MI. |
oxygen
loop diuretics. ACI inhibitors and nitrates beta-blockers inotropic |
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Management of Acute STEMI-Induced
Heart Failure: Cardiogenic shock usually occurs within ...-... hours after hospital admission. It is almost always associated with diffuse coronary disease and significant LV myocardial damage. CHF usually occurs w/in ...-... hrs Arrhythmias usually occur w/in ... |
24-48
48-72 the first 12 hrs |
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Treatment of cardiogenic shock requires early vigorous assessment and management.
Coronary artery ... must be considered early. ... have no role in the treatment of cardiogenic shock. |
reperfusion
Fibrinolytics |
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Cardiac Arrhythmias:
The most common arrhythmia is .... ... is the most common cause of sudden death associated with acute STEMI. Occasional PVC’s occur in almost 100% of all acute MI’s. |
ventricular fibrillation (VF)
VF |
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Cardiac Arrhythmias:
Occasional PVC’s are not treated medically. However, if PVC’s occur frequently and are sustained, the patient is treated with .... Prophylactic IV ... is now contraindicated. |
beta-blockers
lidocaine |
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Cardiac arrhythmias:
-Serum electrolytes, especially potassium and magnesium, are carefully monitored and adjusted. -Ventricular tachycardia and fibrillation may occur without warning. -Intravenous ... is considered the drug of choice for sustained ventricular arrhythmia. |
amiodarone
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Cardiac arrhythmias:
Supraventricular cardiac arrhythmias -... is the most common supraventricular arrhythmia. -... overstimulation may be the most common cause. -... are the treatment of choice. -Atrial fibrillation and atrial flutter may also occur with acute STEMI. |
Sinus tachycardia
Sympathetic Beta-blockers |
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Cardiac Arrhythmias:
Sinus bradycardia -Treat if there is hemodynamic compromise such as symptomatic hypotension. -... given IV is the most useful therapy. -Persistent bradycardia less than 40 bpm should be treated with electrical cardiac pacing. |
Atropine
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Thromboembolism:
... emboli generally cause a CVA and may be fatal. |
Arterial
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Left Ventricular aneurysm:
The complications of a LV aneurysm include CHF, peripheral arterial embolism, and ventricular arrhythmias. ... aneurysms are most common and are easy to detect with echocardiogram. A ... may occur within the aneurysm. |
Apical LV
mural thrombus |
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Left Ventricular aneurysms:
The pseudoaneurysm becomes very susceptible to ... and cardiac tamponade. For this reason, pseudoaneurysms should be treated .... |
rupture
surgically |
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Post-MI Surveillance:
Patients considered to be at high risk for recurrent acute MI or sudden cardiac death -Age >.... -Diabetes Mellitus. -Prolonged recurrent arrhythmia. -Hypotension. -Advanced Heart Block. |
75
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