Critical exam 2=Acute MI (8pts)

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nika.steffan
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237404
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Critical exam 2=Acute MI (8pts)
Updated:
2013-09-27 17:10:37
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Acute Myocardial infarction MI diagnosis treatment complications prevention
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Acute MI- diagnosis & treatment + complications-prevention & treatment
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  1. STEMI
    • ST-elevated myocardial infarction (acute MI) 
    • Irreversible necrosis of heart muscle caused by inadequate blood supply to the coronary arteries
    • Red fibrin rich, full occlusion, stable thrombus
  2. NSTEMI
    • Non-ST elevated myocardial infarction aka Non-Q wave 
    • White platelet, partial occlusion, unstable thrombus
  3. Risk factors for an acute MI
    • 65+
    • Gender- 39% women die while 31% men die from first MI
    • Family hx
    • Ethnicity- black d/t HTN; mexican, indian, hawaiian, asain d/t obesity & DM
    • Hyperlipidemia
    • HTN
    • DM
    • Smoking
    • BC- 2nd gen especially
    • Obese, diet high in fat
    • Physical inactivity
    • Stress/Anxiety
    • Depression
    • CT disease
    • ^homocystine levels (>60) 
    • ^ C-reactive protein (>3) 
    • Cocaine & Meth use
  4. Ischemia
    • T wave inversion
    • Reversible
    • 1st to occur
  5. Injury
    • ST segment elevation
    • Reversible 
    • 2nd to occcur
  6. Infarction
    • Pathologic Q waves
    • Not reversible
    • Last to occur
  7. Inferior infarction - EKG changes/leads seen in
    • Occlusion of RCA
    • Leads II, III, aVf
  8. Anterior Infarction- EKG changes/leads seen in
    • Occlusion of Left Anterior Descending artery
    • Loss of R wave progression in V2, V3, V4
  9. Septal Infarction- EKG changes/leads seen in
    • RCA-posterior 1/3 of septum & LAD anterior 2/3 of septum
    • Loss of small septal R in leads V1&V2
  10. Lateral Infarction- EKG changes/leads seen in
    • Circumflex coronary artery
    • New Q wave and T wave changes seen in leads I, aVL, V5, V6
  11. Posterior Infarction- EKG changes/leads seen in
    • Occlusion of RCA or circumflex (reciprocal changes)
    • Very tall R wave & T wave w/ depressed ST in leads V1 and V2
  12. Describe the chest pain in pt with acute MI
    • New onset- at rest or activity
    • Not relieved by rest or NTG
    • Crushing, squeezing, constricting, elephant on chest
    • Usually increases over minutes
    • May radiate to jaw, shoulder, arms, neck, back
  13. Clinical manifestations of acute MI
    • Chest pain
    • N&V
    • Diaphoresis
    • Tachycardia
    • HTN/Hypotension
    • Skin-pale grey, clammy, cold
    • Dyspnea or rales
    • Diminished peripheral pulses
    • S3/S4
    • Low grade fever
  14. Labs Tests done w/ Acute MI
    • CBC
    • glucose
    • electrolytes
    • Cr (.6-1.3)
    • CK-MB increase (0-5)
    • Troponin I increases in 3-5 hrs (<.4) *PREFERRED METHOD
    • Troponin T increases (<.1) 
    • Myoglobin (0-85)
  15. What is the proffered biomarker for diagnosing myocardial necrosis?
    • Troponin I 
    • Elevations seen within 3-12 hrs, peak at 24hrs, and return to normal in 5-10 days
    • Normal = <.4 ng/mL
  16. Diagnostic Tests done with acute MI
    • Chest x-ray
    • 12-lead EKG
    • Echocardiogram
    • Cardiac Catheterization
  17. What does "time is myocardium" mean?
    • Minutes can mean the difference between life or death
    • Salvage as much of the myocardium as quickly as possible through O2, ASA, NTG
  18. Drugs used in treating acute MI=
    • 1. Beta blockers- lol
    • 2. Lipid lowering drugs- statins 
    • 3. ASA/antithrombotics
    • 4. Anti-coagulants - heparin 
    • 5. ACE inhibitors- pril 
    • 6. ARBs- tan
    • 7. CCB -Nifedipine, amlopidine, verapamil,diltizem
    • 8. Anti-arrhythmics - amiodarone, cardizem
  19. Afterload reducing drugs...
    • IV CCB "pines" : Nicardipine (Cardene) 
    • ACE-inhibitors: Captopril or Enalapril
    • Sodium Nitropusside (Nipride) 

    Others: nesiritide, antihypertensives, ARBs, Milirone
  20. Primary goals of treatment of an MI
    • 1. Preserve the myocardium
    • 2. Treat arrhythmias
    • Others: decrease myocardial O2 consumption, pain relief, prevent/Tx cardiac arrhythmias, preserve the myocardium
  21. ACC recommendation of Tx for STEMI
    • 1. Brief assess: VS, O2
    • 2. 12-lead EKG
    • 3. Lab drawn for cardiac markers (troponin, ck-mb)
    • 4. ASA
    • 5. Morphine -pain
    • 6. Heparin- anticoag
    • 7. Plavix
    • 8.NSAID
    • Teaching
  22. List the complications of acute MI
    • Arrhythmias
    • CHF
    • Hypotension** Emergency post-NSTEMI
    • Pulmonary Embolism
    • Pulmonary Edema
    • Extension of infarction
    • Re-occlusion of affected artery
    • RV infarction
    • Acute pericarditis
    • Post-MI syndrome
    • Cardiac tamponade
    • Structural defects
    • Cardiogenic shock
    • Metabolic acidosis
    • Decreased organ perfusion *Emergency post-NSTEMI

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