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14 Cards in this Set
- Front
- Back
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What size plaques are preferentially prone to rupture?
How is the Dx of STEMI made? |
smaller plaques
History + ECG |
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What ECG changes are necessary for Dx of STEMI?
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Chest pain + (new ST elevation or new LBBB)
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ECG ST elevation in theses areas suggests infarct where:
V1, V2 V3-V4 II, III, aVF I, aVL, V5, V6 V3-V6, aVL, I |
Ant. septal
anterior inferior lateral anterior lateral |
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How do we stratify risk in STEMI pts? Is it structured like the TIMI score?
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based on hemodynamic status of the pt.
No, these are more accurate b/c they're based on "in the moment" measures |
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Describe the Killip Classifications of STEMI. What are they based on?
Occlusions in STEMI are usually... NSTEMI? |
based on clinical examination (auscultation)
I = normal = 6% mortality II = crackles = 17% mortality III = Pulm. Edema = 38% IV = cardiogenic shock = 83(60)% Complete. Can be partial |
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What are the two main reperfusion options in STEMI pts? What are the two types of one of those options?
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Thrombolytics and PCI
Fibrin-specific plasminogen activators (only go after stuff that's actively clotting) Non-fibrin specific plasminogen activations (go after the fluid phase) |
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Do Thrombolytics work in BBB? Anterior STEMI? Inferior STEMI? ST Depression?
What are the absolute contraindication to Thrombolytic use? Does time to Tx matter? When is the greatest benefit seen? Plateau? |
Yes, they basically work in everything except ST depression.
any prior intracranial hem. known CV lesion known intracranial neoplasm suspected aortic dissection ischemic stroke w/i past 3 months ...bascially, things that suggest head bleeding = bad. Yes! Greatest benefit is seen in the 1st hour. Minimal additional benefit after 3hrs. |
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What is the most studied procedure in medicine? Success rate at achieving reperfusion?
Does timing matter? |
Angioplasty.
95% Yes, every 30min delay in primary PCI results in 7.5% relative increase in 1y mortality |
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In acute MI w/i 1hr, the data suggest that which is better, thrombolytics or PCI?
After 1hr, does PCI have a survival benefit vs thrombolytics? What does this mean? **really think about this** understand why the choices in the lab cases were made. |
PCI is better.
not really. If there is a situation in which it would take awhile to get in with a PCI, consider using thrombolytics. |
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Do most pts in the US present of a PCI-capable hospital?
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No, 80% do not.
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What are the mechanical complications of STEMI?
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Papillary muscle rupture/dysfunction
Ventricular septal rupture free wall rupture |
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Which papillary muscle is usually involved in rupture? Why? When does this occur?
What is the result? |
Posterior medial b/c it receives singular blood supply from the RCA; 2-7d post inferior MI
Acute mitral regurgitation pulmonary edema |
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Rupture of the ventricular septum is secondary to _____. Occurs when? Mortality?
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necrosis
1wk post MI v. high mortality rate |
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How freq is free wall rupture?
usual location? when does it occur? Mortality? |
1-4% of all STEMI pts.
usually involved rutpure on the lateral wall i/ first 5 days nearly all cases are fatal |
