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42 Cards in this Set

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  • Back
What sort of pH changes set in during/post MI
Metabolic Acidosis (tissues hypoperfused go anaerobic, thus a Lactic acidosis too
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
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
What commonly initiates V-tach from sinus rhythm
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
Treatment for Polymorphic V-Tach/V-Fib?
Cardiovert asap
What is AIVR
Accelerated Idio-Ventricular Rhythm: Arry caused by post thrombolytic meds=post perfusion (reperfusion) inury
What sort of QRS does AIVR have
big, fat wide complex but NOT FAST/tachy
-60-100bpm
-benign ventricular rhythm
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
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
Supraventricular Tachys occur in 1/3 of Pts with what MI
Anterior MI
What other Arrys are commonly assc with MIs
BBB and Hemi Blocks
-generally RBBB + LAHB
others include RBBB + LPHP
Alternating BBB
Mobitz II
Trifasicular
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
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
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
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
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
What is invasive monitoring for CS
Swan Ganz Catheter for PCWP
--the higher the reading, the wetter they are
What drugs might be used for the hypotension in CS
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)
-
What is IABP
Aortic Counterpulsation--balloon in aorta inflates during diastole to inc. coronary flow
--DONT use in Aortic disection or AI
What other Arrys are commonly assc with MIs
BBB and Hemi Blocks
-generally RBBB + LAHB
others include RBBB + LPHP
Alternating BBB
Mobitz II
Trifasicular
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
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
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
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
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
What is invasive monitoring for CS
Swan Ganz Catheter for PCWP
--the higher the reading, the wetter they are
What drugs might be used for the hypotension in CS
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)
-
What is IABP
Aortic Counterpulsation--balloon in aorta inflates during diastole to inc. coronary flow
--DONT use in Aortic disection or AI
Hypotension, Clear Lungs, Increased JVP, Positive Kussmaul, Hepatomegalia, INC Paradox Pulse indicate what
Right Ventricular Failure
assc. w/ RCA occlusio/ Inferior MI

-take V leads and move to right side
With RVF/Inferior MI, what V leads (moved to right) will show what?
V3 - V5 will show Greater than 1mm voltage rise in ST segment
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
Tx for RVF from RV Infarction
Volume
Inotropic agent (dobutamine)
--DO NOT Give VasoDilatorss--DO Give PRessors---ie, avoid Nitrates or other dilators that would reduce filling pressure and output
What comp for MI develops new murmur and pulm edema and shock quickly
Ruptured Pap mm --posterior medial more common than anterior lateral mm
--Assc with Inferior MI > Anterior MI
---Usually onsets 3-5 days post MI
Name 5 impt Sx for ruptured pap
Holosystolic Murmur
MR
Pulm edema
HF
Hypotension
(seems like shock)
Tx for Ruptured Pap mm.
IABP, decrease afterload of LV to reduce volume of regurge
Surgery
--high mortality 40-90%
This MI complication (2/3) from Anterior MI > inferior MI) brings new murmur, loud, holosystolic, LSB, thrill
VSR
Ventricular Septal Rupture
(may just be written as a VSD)
TX for VSR
IABP, Inotropic, Vasodilator, Surgery
50% of this MI complication happen with Anterior MI
Free wall rupture
--3-5 days post Ant MI
====Sudden loss of Pulse, BP &
--Tamponade
What is Tx for Free wall rupture
Pericardiocentesis, Surgery
This MI complication can occur weeks/months after STEMI
-causing HF, arrys, arterial clots
LV Aneurysm
-TX is Anticoag if mural thrombus identified
With what MI is Pericarditis assoc. and when is onset
Pericarditis
assc w/ STEMI, 2-4 days later
Sx of Pericarditis
Chest Pain, Hurts to Breath, Relief leaning forward
-may hear friction rub

-Similar inflammation known as Dressler's Syndrome --tx with ASA