S2: Ch1 Cv 1-3

Front 1

94. Location of changes on ECG for anterior infarct?

Back 1

a. S-T segment elevation in V1-V4 (acute/active)
b. Q waves in V1-V4 (late change)

Front 2

95. Location of changes on ECG for posterior infarct?

Back 2

a. Large R wave in V1 and V2.
b. S-T segment depression in V1 and V2
c. Upright and prominent T waves in V1 and V2.

Front 3

96. Location of changes on ECG for lateral infarct?

Back 3

a. Q waves in leads I and aVL (late change)

Front 4

97. Location of changes on ECG for inferior infarct?

Back 4

a. Q waves in leads II, III, and aVF (late change).

Front 5

98. Note: Augmented ECG leads from aVL indicate the left arm, and from aVF, indicate the left foot.

Back 5

98. Note: Augmented ECG leads from aVL indicate the left arm, and from aVF, indicate the left foot.

Front 6

99. Complications of acute MI?

Back 6

1. Pump failure
2. Arrhythmias
3. Recurrent infarction (extension of existing infarction or reinfarction of a new area.
4. Mechanical complications
5. Acute pericarditis
6. Dressler’s syndrome “Postmyocardial infarction syndrome”

Front 7

100. Pump failure?

Back 7

a. Most common cause of in-hospital mortality.
b. If mild, treat medically (ACE inhibitor, diuretic).
c. If severe, may lead to cardiogenic shock; invasive hemodynamic monitoring may be indicated.

Front 8

101. Arrhythmias following acute MI- just to prep?

Back 8

a. PVCs
b. Atrial fibrillation
c. Ventricular tach
d. Vfib
e. Accelerated idioventricular rhythm
f. Paroxysmal supraventricular tachycardia (PSVT)
g. Sinus tachy
h. Sinus Brady
i. Asystole
j. AV block

Front 9

102. Tx of PVCs following acute MI?

Back 9

a. conservative tx (observation) indicated; no need for antiarrhythmic agents?

Front 10

103. Tx of Ventricular tachycardia following acute MI?

Back 10

a. Sustained VT requires tx.
b. If pt is hemodynamically unstable, electrical cardioversion is indicated.
c. If pt is hemodynamically stable, start antiarrhythmic therapy (IV amiodarone).

Front 11

104. Tx of Vfib following acute MI?

Back 11

a. Immediate unsynchronized defibrillation and CPR are indicated.

Front 12

105. Tx of Accelerated idioventricular rhythm following acute MI?

Back 12

a. Does not affect prognosis. No tx needed in most cases.

Front 13

106. Tx of Paroxysmal supraventricular tachycardia (PVST) following acute MI?

Back 13

a. No tx.

Front 14

107. Cause of and Tx of Sinus tach following acute MI?

Back 14

a. May be caused by pain, anxiety, fever, pericarditis, meds, etc.
b. Worsens ischaemia (increases myocardial oxygen consumption.
c. Tx underlying cause (analgesics for pain, aspirin for fever, etc).

Front 15

108. Tx of Sinus bradycardia following acute MI?

Back 15

a. A common occurrence in early stages of acute MI.
b. May be protective mechanism (reduces myocardial oxygen demand)
c. No tx required other than observation. If brady is severe or symptomatic (hemodynamic compromise), atropine may be helpful in increasing HR.

Front 16

109. Tx of asystole?

Back 16

a. V. high mortality.
b. Tx should begin w/electrical defibrillation for VFib, which is more common in cardiac arrest and may be difficult to clearly differentiate from asystole.
c. If asystole is clearly the cause of arrest, transcutaneous pacing is the appropriate tx!

Front 17

110. Tx of 1st and second-degree (type 1) AV block?

Back 17

a. Assoc w/ischaemia involving conduction tracts.
b. First-degree and second-degree (type 1) block do not require therapy.

Front 18

111. Tx of second-degree (type II) and 3rd-degree block?

Back 18

a. Prognosis is dire in the setting of an anterior MI- emergent placement of a temporary pacemaker is indicated (with latter placement of a permanent pacemaker).
b. In inferior MI, prognosis is better, and IV atropine may be used initially.
c. If conduction is not restored, a temporary pacemaker is appropriate.

Front 19

112. Recurrent infarction (extension of existing infarction or reinfarction of a new area)?

Back 19

a. Diagnosis is often difficult.
b. Cardiac enzymes are already elevated from the initial infarction.
c. Troponin levels remain elevated for a week or more, so are not useful here.
d. CK-MB returns to normal faster, and so a re-evaluation of CK-MB after 36-48 hours may be due to recurrent infarction.
e. If there is repeat S-T segment elevation on ECG w/in the first 24 hours after infarction, suspect recurrent infarction.

Front 20

113. Tx of recurrent infarction?

Back 20

a. Repeat thrombolysis or urgent cardiac cath and PTCA.
b. Continue standard medical therapy for MI.

Front 21

114. Mechanical complications of MI- Free wall rupture?

Back 21

a. A catastrophic, usually fatal event that occurs during the first 2 wks after MI (90% w/in 2 wks, most commonly 1-4 days after MI)
b. 90% mortality rate.
c. Usually leads to hemopericardium and cardiac tamponade.

Front 22

115. Tx of Free wall rupture?

Back 22

a. Hemodynamic stabilization
b. Immediate pericardiocentesis
c. Surgical repair.

Front 23

116. What 7 Rx are indicated in pts w/MI?

Back 23

1. Morphine
2. Oxygen
3. Nitro
4. Aspirin
5. Ace inhibitor
6. IV heparin
7. β-blocker.

Front 24

117. What did the HOPE trial indicate regarding ACE inhibitors?

Back 24

a. That the ACE inhibitor, ramipril, reduces mortality in MI, stroke, and renal disease in a broad range of pts w/high-risk C/V disease.

Front 25

118. What did the GUSTO trial demonstrate regarding thrombolytics?

Back 25

a. Showed that t-PA plus IV heparin gave the greatest mortality benefit compared w/other thrombolytic regimens (streptokinase and IV/SC heparin) in pts w/acute MI.

Front 26

119. Is there a correlation between MI and stroke?

Back 26

a. Pts who suffer an acute MI have a high risk of stroke during the next 5 yrs.
b. The lower the EF and the older the pt, the higher risk of stroke.

Front 27

120. Mechanical complications of MI-Rupture of IV septum?

Back 27

a. Greater potential for successful therapy than w/a free wall rupture, although this is also a critical event; emergent surgery is indicated.
b. Occurs w/in 10 days after MI.
c. Likelihood of survival correlates w/size of defect.

Front 28

121. Mechanical complications of MI-Papillary muscle rupture?

Back 28

a. Produces mitral regurg!!!!!
b. If suspected, obtain an echo immediately.
c. Emergent surgery is needed (mitral valve replacement is usually necessary), as well as afterload reduction w/sodium nitroprusside or intra-aortic balloon pump (IABP).

Front 29

122. Mechanical complications of MI-Ventricular pseudoaneurysm?

Back 29

a. Incomplete free wall rupture (myocardial rupture is contained by pericardium)
b. Bedside echo may show pseudoaneurysm.
c. Surgical emergency bc ventricular pseudoaneurysm tend to become a free-wall rupture.

Front 30

123. Mechanical complications of MI-Ventricular aneurysm?

Back 30

a. Rarely rupture (in contrast to pseudoaneurysm)
b. Assoc. w/a high incidence of ventricular tachyarrhythmias.
c. Medical management may be protective.
d. Surgery to remove aneurysm may be appropriate in selected pts.