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42 Cards in this Set
- Front
- Back
What sort of pH changes set in during/post MI
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Metabolic Acidosis (tissues hypoperfused go anaerobic, thus a Lactic acidosis too
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With MI, Pt has PVCs causing V-tach <30 seconds per episode
Diagnose? Tx? |
Nonsustained V-tach-- monitor K, Mg.
MAY choose to give Beta blocker, but condition not assc w/ inc. mortality |
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With MI, Pt has V-tach >30 seconds per episode & hemodynamic compromise
Diagnose? Tx Unstable? Stable? |
Sustained VT--assc w/ 20% in hospital mortality
if Unstable- cardiovert/shock if Stable--Amiodarone, Procainamide |
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What commonly initiates V-tach from sinus rhythm
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Fusion or Dressler beat
--QRS doesn't look like any of the previous sinus beats NOR does it look like the tachycardic beats that follow |
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Treatment for Polymorphic V-Tach/V-Fib?
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Cardiovert asap
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What is AIVR
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Accelerated Idio-Ventricular Rhythm: Arry caused by post thrombolytic meds=post perfusion (reperfusion) inury
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What sort of QRS does AIVR have
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big, fat wide complex but NOT FAST/tachy
-60-100bpm -benign ventricular rhythm |
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RCA occlusion is associated with What MI AND What Arrys?
Why? |
Inferior Wall MI (II, III, aVF)
Brady--RCA yields SA Nodal Artery & AV nodal A. AV Blocks: 1st degree, 2nd Degree Wenckebach/Mobitz I |
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What MI/Coronary Occlusion is a 2nd Degree AV Block-Mobitz Type II associated with?
Why? |
Anterior MI (V1-V6)/ LAD Art.
--2nd Degree AV Block-Mobitz type II---this is the type that's below the AV node --3rd Degree AV blocks too |
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Supraventricular Tachys occur in 1/3 of Pts with what MI
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Anterior MI
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What other Arrys are commonly assc with MIs
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BBB and Hemi Blocks
-generally RBBB + LAHB others include RBBB + LPHP Alternating BBB Mobitz II Trifasicular |
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Post MI, what is most important determinant for prognosis?
Tx to help? |
LV dysfunction (ie, dilatation, shape--remodeling)
ACE Ibxs designed to prevent remodeling in add to volume control |
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Describe the Killip classifications for heart function
4 classes |
I: no signs of congestion
II: moderate HF --crackles, S3, tachypnea; moderate RHF w/ hepatic congestion III: severe HF--pulm edema IV:cardiogenic shock--systolic <90, cyanosis, confusion |
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What must be excluded before jumping to HF if Pt is Hypotensive and does NOT have pulmonary congestion?
Tx? |
Hypovolemia--causes low BP (among other HF Sx)
--If so, give IV fluids If HF & IF Wet--give diuretics, ACEs, BB--dec MV02, HR, BP Nitrates to dec. preload/afterload |
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Of the 5 causes of cardiogenic shock (CS--has 50% mortality), which cuases 80% of CS?
List other 4 |
1. LV failure--80% of CS from AMI
2. VSR (vent septum rupture) 3. Pap mm./chordal ruputre=severe MR 4. Ventricular Free Wall Rupture-= tamponade 5. RVF |
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Describe the Hemodynamic changes for CS for:
CO (SVXHR) CL (clearance?) PCWP BP PADP (pulm art dia pre??) SVR (systemic vasc, resis) |
CO (SVXHR): DEC
CL: DEC PCWP: INC BP: DEC LVEDP : INC SVR: INC |
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What is invasive monitoring for CS
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Swan Ganz Catheter for PCWP
--the higher the reading, the wetter they are |
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What drugs might be used for the hypotension in CS
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Vasopressors (not really shown to work)
-NorEpi: system BP inc. by vasocon. Also inotropic stimulant -Dopamine: dilates RENAL & vasc bed(not too high else alpha stim sted of beta) -Dobutamine: sympathomimetic (inotrophic/chronotrophic on heart) - |
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What is IABP
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Aortic Counterpulsation--balloon in aorta inflates during diastole to inc. coronary flow
--DONT use in Aortic disection or AI |
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What other Arrys are commonly assc with MIs
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BBB and Hemi Blocks
-generally RBBB + LAHB others include RBBB + LPHP Alternating BBB Mobitz II Trifasicular |
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Post MI, what is most important determinant for prognosis?
Tx to help? |
LV dysfunction (ie, dilatation, shape--remodeling)
ACE Ibxs designed to prevent remodeling in add to volume control |
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Describe the Killip classifications for heart function
4 classes |
I: no signs of congestion
II: moderate HF --crackles, S3, tachypnea; moderate RHF w/ hepatic congestion III: severe HF--pulm edema IV:cardiogenic shock--systolic <90, cyanosis, confusion |
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What must be excluded before jumping to HF if Pt is Hypotensive and does NOT have pulmonary congestion?
Tx? |
Hypovolemia--causes low BP (among other HF Sx)
--If so, give IV fluids If HF & IF Wet--give diuretics, ACEs, BB--dec MV02, HR, BP Nitrates to dec. preload/afterload |
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Of the 5 causes of cardiogenic shock (CS--has 50% mortality), which cuases 80% of CS?
List other 4 |
1. LV failure--80% of CS from AMI
2. VSR (???) 3. Pap mm./chordal ruputre=severe MR 4. Ventricular Free Wall Rupture-= tamponade 5. RVF |
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Describe the Hemodynamic changes for CS for:
CO (SVXHR) CL (clearance?) PCWP BP PADP (pulm art dia pre??) SVR (systemic vasc, resis) |
CO (SVXHR): DEC
CL: DEC PCWP: INC BP: DEC LVEDP : INC SVR: INC |
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What is invasive monitoring for CS
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Swan Ganz Catheter for PCWP
--the higher the reading, the wetter they are |
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What drugs might be used for the hypotension in CS
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Vasopressors (not really shown to work)
-NorEpi: system BP inc. by vasocon. Also inotropic stimulant -Dopamine: dilates RENAL & vasc bed(not too high else alpha stim sted of beta) -Dobutamine: sympathomimetic (inotrophic/chronotrophic on heart) - |
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What is IABP
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Aortic Counterpulsation--balloon in aorta inflates during diastole to inc. coronary flow
--DONT use in Aortic disection or AI |
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Hypotension, Clear Lungs, Increased JVP, Positive Kussmaul, Hepatomegalia, INC Paradox Pulse indicate what
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Right Ventricular Failure
assc. w/ RCA occlusio/ Inferior MI -take V leads and move to right side |
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With RVF/Inferior MI, what V leads (moved to right) will show what?
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V3 - V5 will show Greater than 1mm voltage rise in ST segment
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With RVF causing Paradoxial Pulse, what is DDX
--ie, consider these in add to RVF/ Inf. MI |
Hypotension/volemia from LV infarction
PE Cardiac Tamponade Constrictive Pericarditis |
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Tx for RVF from RV Infarction
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Volume
Inotropic agent (dobutamine) --DO NOT Give VasoDilatorss--DO Give PRessors---ie, avoid Nitrates or other dilators that would reduce filling pressure and output |
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What comp for MI develops new murmur and pulm edema and shock quickly
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Ruptured Pap mm --posterior medial more common than anterior lateral mm
--Assc with Inferior MI > Anterior MI ---Usually onsets 3-5 days post MI |
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Name 5 impt Sx for ruptured pap
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Holosystolic Murmur
MR Pulm edema HF Hypotension (seems like shock) |
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Tx for Ruptured Pap mm.
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IABP, decrease afterload of LV to reduce volume of regurge
Surgery --high mortality 40-90% |
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This MI complication (2/3) from Anterior MI > inferior MI) brings new murmur, loud, holosystolic, LSB, thrill
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VSR
Ventricular Septal Rupture (may just be written as a VSD) |
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TX for VSR
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IABP, Inotropic, Vasodilator, Surgery
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50% of this MI complication happen with Anterior MI
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Free wall rupture
--3-5 days post Ant MI ====Sudden loss of Pulse, BP & --Tamponade |
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What is Tx for Free wall rupture
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Pericardiocentesis, Surgery
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This MI complication can occur weeks/months after STEMI
-causing HF, arrys, arterial clots |
LV Aneurysm
-TX is Anticoag if mural thrombus identified |
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With what MI is Pericarditis assoc. and when is onset
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Pericarditis
assc w/ STEMI, 2-4 days later |
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Sx of Pericarditis
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Chest Pain, Hurts to Breath, Relief leaning forward
-may hear friction rub -Similar inflammation known as Dressler's Syndrome --tx with ASA |