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32 Cards in this Set
- Front
- Back
Most common cause of acute MI
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Destabilization of atherosclerotic plaque with subsequent thrombus formation
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Name 2 causes of acute MI where thrombolytic therapy is contraindicated
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Embolic phenomenon
Thoracic aortic dissection |
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3 " big factors" in diagnosis of acute MI
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Symptoms
EKG Serum cardiac markers Dont need to meet all 3 - can meet just two - dont need to wait for cardiac markers |
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Detects MI as a “hot spot” on the nuclear scan between 24 hours and 5 days after symptom onset – not useful in acute setting
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99mTc-pyrophosphate scan
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Positive scan (a “hot spot” on the nuclear scan) may be seen in:
Acute MI Unstable angina pectoris Active myocarditis Cardiac transplantation rejection |
111In-antimyosin scan
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Differential diagnosis of chest discomfort - CARDIOVASCULAR
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-Acute MI
-Unstable angina -Prinzmetal’s (variant) angina -Acute pericarditis -Valvular heart disease (AS, MVP, MS) -Hypertrophic cardiomyopathy -Thoracic aortic dissection -Myocarditis (occasionally) |
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Patient presents with jabbing sensation in chest, gets better on sitting up, worse when taking a breath - diagnosis
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Acute pericarditis
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Differential diagnosis of chest discomfort - PULMONARY
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-Pumonary embolism (PE)
-Pneumothorax -Bronchitis -Pneumonia -Pleuritis (pleurisy) -Asthma -Severe pulmonary hypertension |
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Differential diagnosis of chest discomfort _ GI
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-Esophagitis
-Esophageal spasm -Gastritis -Peptic ulcer disease (PUD) -Biliary colic (cholecystitis, etc.) -Pancreatitis -Mallory-Weiss syndrome - tear from excessive vomitting (alcoholics) |
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Differential diagnosis of chest discomfort - Musckuloskeletal
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-Costochondritis
-Tietze syndrome:Tenderness and swelling of the costal cartilage -Myositis -Somatic dysfunction -Chest or upper extremity trauma -Thoracic outlet syndrome – 1st rib dysfunction |
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Differential diagnosis of chest discomfort - Neurological
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-Herpes zoster
-Intercostal neuralgia |
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How do you decrease myocardial oxygen demand
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-Bed rest
-NPO until stable -Double product Beta blockade (unless contraindicated) Other antihypertensives (if BP is elevated) Avoid agents known to cause reflex tachycardia Digoxin - may be of value for tachycardia associated with hypotension or CHF -Analgesics |
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How do you increase myocardial oxygen supply
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-Supplemental O2
-Relieve pulmonary vascular congestion (if present) -Diuretics, IV NTG, MSO4 -Acute revascularization -Thrombolytic therapy Standard of care (in hospitals without primary PCI capability) -Mechanical revascularization -Catheter-based intervention -CABG surgery -Intra-aortic balloon pump (IABP)-If cardiogenic shock and if cath lab available |
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Benefits of using thrombolytic therapy
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-Lyses occlusive coronary thrombus rapidly
-Improves LV function -Reduces both short-term and long-term mortality |
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Risks of thrombolytic therapy
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-Bleeding
-Anaphylaxis (SK and APSAC) -Hypotension -Arrhythmia (reperfusion) |
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Time frame for most beneficial use of thrombolytics
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Less than 6 hours from onset
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Less beneficial but still worthwile use of thrombolytic therapy - time frame
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6-12 hours from onset
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Time frame when thrombolytic therapy gives little apparent benefit unless there is ongoing chest discomfort or a “stuttering” course
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Over 12 hours from onset
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EKG criteria for acute MI
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-ST segment elevation > 1 mm in 2 or more contiguous precordial or limb leads
-New (or presumed new) LBBB -ST segment depression with prominent R waves in leads V1 and V2, if this is thought to represent a posterior wall infarction rather than unstable angina |
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Which therapy is standard of care in patients with MI
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Thrombolytic
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Name contraindications for thrombolytic therapy
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-Any prior intracranial hemorrhage
-Known structural cerebral vascular lesion (e.g., arteriovenous malformation) -Known malignant intracranial neoplasm (primary or metastatic) -Ischemic stroke within 3 months (except acute ischemic stroke within 3 hours) -Significant closed-head or facial trauma within 3 months -Suspected aortic dissection -Active bleeding or bleeding diathesis – problem with coagulation (excluding menses) |
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Indications for catheter based intervention
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-Patients at high risk for thrombolytic therapy
-Cardiogenic shock |
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Indications for CABG
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-Patients with CAD which is not amenable to catheter-based revascularization
-Patients with mechanical complications of acute MI |
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IV nitroglycerin should be avoided in _
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Right ventricular infarctions
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Medications to avoid unless a clear-cut indication exists in a patient with aMI
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-Calcium channel blockers
-Lidocaine -IV magnesium |
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Mechanical complications of MI
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Acute mitral regurgitation
Ventricular septal rupture Ventricular pseudoaneurysm Ventricular free wall rupture |
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Most mechanical complications of MI can be diagnosed by _
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ECHO
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Most mechanical complications of MI can be treated by _
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IABP insertion followed by emergent open-heart surgery
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Peak incidence of mechanical complications of MI
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3-5 days
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Patient with MI + a. fib.flutter - management?
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-Electrical cardioversion if patient is unstable
-Otherwise, control ventricular rate with medical therapy (beta-bockade, digoxin) and anticoagulate. |
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Patient with MI + V fib/V tach - do you need to do EPS
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Generally, EPS is not indicated if V. tach. or V. fib. occurs within 48 hours of acute MI.
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Treatment for patient with MI +
BRADYARRHYTHMIA -Sinus bradycardia -AV block -Asystole |
-Observation only
-Atropine -Temporary pacemaker (external or transvenous) -Permanent cardiac pacemaker |