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Flashcards in myocardial infarction Deck (15)
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1
Q

What is the next step for a pt with reversible myocardial ischemia?

A

cardiac catheterization- must assess need for percutaneous transluminal coronary angiopalsty or CABG

2
Q

When are enzymes measured in acute MI?

A

q8 hrs over first 24 hrs- total of 3 troponin measurements

  • CK-MB increases 2-12 hrs post-MI peaks, at 12-40 hrs, and is decreasing on days 1-3
  • troponins rise fast (2-3 hrs), peak at 6 hrs, but stay high for 7 days
3
Q

what leads show anterior infarct? what is the vessel?

A

V2, V3, V4

LAD

4
Q

what leads show a septal infarct?

A

V1, V2, V3

5
Q

what leads show an interior infarct? coronary artery branch?

A

leads II, III, aVF

this is a posterior descending or marginal infarct

6
Q

What leads show a lateral infarct?

A

I, aVL, V4, V5, V6; usually LAD or left circumflex

7
Q

What leads show a posterior infarct?

A

V1, V2. usually there is a comorbid inferior MI due to occlusion of the posterior descending

8
Q

What is the treatment for acute MI?

A

-IV morphine, supplemental O2, nitroglycerine, ASA, heparin, BB, statin and antiplatelet like clopidogrel or ticagrelor

9
Q

What is the treatment for a STEMI?

A
  • perform PCI (percutaneous coronary intervention) and give a GP IIb/IIIA inhibitor (like abiciximab, tirofiban, epifibatide)
  • If PCI not possible in first 12 hrs post-MI, consider tPA or urokinase
  • give K to keep >4 and magnesium to keep >2
  • If emergent catheterization not performed, perform cardiac catheterization to measure vessel patency and consider PTCA or CABG
10
Q

What should be done for hypotensive pt with STEMI?

A

-Stop nitroglycerin, give IV fluids, give amiodarone for pts with Vtach

11
Q

What are long term treatments for post-MI pts?

A

risk reduction including ASA or clopidogrel, BB, ACE-I or ARB, statin, exercise, smoking cessation
consider aldosterone antagonist

12
Q

what are the common complications of MI?

A

infarct extension, arrhythmias, aneurysm, mural thrombus, pericarditis, dressler syndrome (fever, pericarditis, and incr. ESR seen 2-4 wks post MI)

13
Q

When is risk of ventricular wall rupture greatest?

A

6-8 days post-MI

14
Q

What medications decrease mortality after MI?

A

BBs and ACE-Is

15
Q

What are some draw-backs of BBs?

A

can have negative effects on patients with asthma, COPD, PVD (peripheral vascular disease), DM (can mask hypoglycemia), and depression