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Cardiovasc 4 MI

Myocardial Infarction

QuestionAnswer
What is the tx for opioid overdose? Naltrexone or naloxone
What is the classic presentation of a pt with an aspirin overdose? Tinnitus, respiratory alkalosis (progresses to a mixes resp and metabolic acidosis with elev anion gap), and hyperthermia. This triad=aspirin OD. Non-specific sx include n/v, dehydration, AMS
What is the first-line tx for a growth hormone secreting pituitary adenoma Transphenoidal tumor resection
What medications should all post-MI pts receive as outpt? Aspirin/clopidogrel, beta blocker, ACE-i/ARB, statin, aldosterone antag (spironolactone)
Which medication types have a proven reduction in mortality following MI? ACE-i/ARB, statins, beta blockers
In what time frame do thrombolytics need to be given in a MI? How does this differ from the time frame for a stroke? MI: within 12 h (tpa decreases mortality only if used within 12h) Stroke: within 3h
What are specific labs ordered in pts suspected of MI? Serial cardiac enzymes (trops and CKMB)
What is the MCC of death in pts with an acute MI? Fatal arrhythmia (V fib)
Name 5 EKG findings seen in case of MI. ST elevation, T wave changes, new arrhythmia, *left bundle branch block*, or Q wave changes *HY*
WHich cardiac enzyme increases 2-12hr post-MI, peaks in 12-40h, and decreases in 24-72h? CPK-MB
Which cardiac enzyme increases in 3h post-MI, peaks in 6h, and decreases over 7d? Troponin (more sens and specific)
Whhich lab might be elevated earlier than trops (~2h)? Myoglobin
What two life-saving interventions should be considered in MI pts? Which one should NOT be used in unstable angina pts? PCI (angio) or fibrinolysis. Fibrinolysis should NOT be used in angina or NSTEMI pts (no proven benefit).
What electrolytes should be controlled during MI and what are the cut-offs for correction? Mg >2 and K >4. Decreases risk of arrhythmia
In what group of pts should you be concerned about using beta blockers like metoprolol during an MI? COPD/asthmatics. Can cause bronchoconstriction. Watch for s/s of asthma attack (wheezing, dyspnea)
Which class of CCB is inappropriate to administer during acute coronary syndrome? Dihydropiridine CCBs (nifedipine, amlodipine). Causes vasoldilation and reflex tachy which can worsen cardiac ischemia. The non-dihydros like verapamil or diltiazem are ok after giving a beta blocker, but show no improval in mortality.
After giving your MI pt the std treatments, she becomes hypotensive. What should be done? Stop nitroglycerin and give IVF
In what time frame post-MI is a pt at risk for wall rupture? 4-5d
MC fatal complication within hours of an MI? V fib (also V tach and cardiogenic shock)
Pt comes in 3 weeks after having an MI complaining of fever and chest pain which is relieved by leaning forward. What is the likely dx? What would you expect to see on labs? Dressler's syndrome (fever, pericarditis, inc ESR 2-4wk post-MI). Increased ESR.
Name the assoc'd coronary arter branch and EKG leads for the area of infarct: anterior wall LAD; V2, V3, V4
Name the assoc'd coronary arter branch and EKG leads for the area of infarct: septal LAD; V1, V2, V3
Name the assoc'd coronary arter branch and EKG leads for the area of infarct: inferior PDA or marginal branch; II, III, aVF
Name the assoc'd coronary arter branch and EKG leads for the area of infarct: lateral LAD or circumflex; I, aVL, V4, V5, V6
Name the assoc'd coronary arter branch and EKG leads for the area of infarct: posterior PDA; V1, V2 (frequent comorbid inferior MI). Check R sided EKG to confirm
Created by: sarah3148
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