Myocardial Infarction and Clinical Cases Flashcards Preview

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Flashcards in Myocardial Infarction and Clinical Cases Deck (24)
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1
Q

What qualifies as STEMI in men?

What about for women?

A

ST elevation of 2mm or greater at J point in V2-3

ST elevation of 1.5mm in absence of LVH or 1mm or more in 2 contiguous chest or limb leads

2
Q

What is indicated by an elongated Q wave?

A

Cardiac tissue death (necrosis)

3
Q

What may lead you to expect a posterior MI?

A

Prominent R wave in V1

ST depression in V2 and V3

4
Q

Besides troponin, what labs may point to an MI?

A

C Reactive Protein elevation

WBC elevation

Brain Natriurietic Peptide (BNP) elevation

5
Q

What is a concerning history for MI?

A

Chest pain, worse than regular angina

heavy/pressure/crushing

retrosternal, left, across the chest, radiating into neck, jaw, left UE, epigastrium, or between sholder blades

assx. n/v, diaphoresis, SOB

20% are silent, esp. in diabetics and elderly women

atypical sx in women and diabetics as well

6
Q

Stable angina, which is chest pain that has been worked up and is not causing ishcemia can progress to unastable angina which is what?

When coronary artery flow is occluded, what happens?

besides atherosclerosis, what else can cause MI?

A

a partial arterial occlusion or NSTEMI

STEMI

vasospasm, vasculitis, dissection, genetics

7
Q

What is the progression of CAD?

A

Normal heart

stable angina with some plaque build up

unstable angina when plaque cap ruptures

NSTEMI when blood clot forms, blocking artery

STEMI when heart tissue dies

8
Q

What are the zones of infarction and what EKG changes are associated?

A

ischemia-def. blood supply with impaired repol. causes T wave changes

Injury-def. blood supply with inability to fully polarize causing ST segment shifts

Infarction-dead tissue, unable to depol. causes changes in Q waves

9
Q

What specific T wave changes do you see with myocardial ischemia?

A

inverted T waves

tall, peaked T waves

depressed ST segment

10
Q

What specific EKG changes do you see in myocardial injury?

A

ST elevation (heart tissue is dying)

11
Q

What specific EKG changes do you see in myocardial infarction or necrosis?

A

Q waves will be bigger, indicating old infarct/dead tissue

12
Q

What is the timeline of Troponin after an MI?

A

Immediately after, may not see any serum changes

1-4 hours after onset levels are detectable

10-24 hours after they peak

persist for 5-14 days

note that renal failure can cause false positives

13
Q

How do you diagnose an NSTEMI?

A

NO ST elevation

elevated toponin, CK, and CK/MB

may have ST depression or T wave inversion, usually in contiguous leads

14
Q

What finding may obscure ST elevations/segments?

A

New LBBB

15
Q

Which leads correlate with which heart area/artery?

LAD

RCA

Circumflex

Posterior Descending A.

A

anterior wall infarct, leads V3, 4

inferior wall/RV infarct, leads 2, 3, avF

lateral wall, leads 1, avL, V5, V6

posterior wall infarct, V1-4

Bonus: Septal-V1-2

16
Q

When is tachycardia normal and when is it pathological?

A

normal: pregnancy, emotions, exertion
bad: drugs, hyperthyroid, fever, pregnancy (also?), anemia, CHF, hypovolemia

17
Q

What can cause bradycardia?

A

vagal responses, sleep apnea, meds, MI, increased ICP, hypothyroid, super fitness

18
Q

what can cause a premature atrial contraction?

A

usually no diseases,

assx with stress, eTOH, tobacco, coffee, COPD and CAD

19
Q

What can cause PVC?

A

can be normal

stress

hypoxia

drugs

heart failure

MI

ischemia

cardiomyopathy

electrolyte dysfunciton (hypokalemia/magnesia, hyperkalemia)

20
Q

While PVCs can be benign, too many of them can cause what?

A

Ventricular tachycardia which can cause someone to become pulseless and die -_-

21
Q

What is ventricular tachycardia?

A

can be nonsustained, sustained or pulseless

QRS complex is wide

can be caused by CAD, heart failure, hypertrophic cardiomyopathy, congenital heart disease, elect. dysfuntion.

give them a “thump” if you can’t shock them

22
Q

What is superventricular tachycardia?

A

narrow QRS complex, fast HR

caused by thyroid issues, caffiene, meds, or stress

atrial rate is usually over 160-180

p wave tends to merge into T or U wave

23
Q

What is atrial fibrillation?

A

atrial rate is 350-600bpm, undulating baseline, no p waves, irregular pr interval

“irregularly irregular” ventricular rhythm

can cause blood clots

24
Q

What is a 1’ degree AV block?

A

Not pathological

PR interval is one large square long and is consistently lengthened