Myocardial Infarction
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| What is the tx for opioid overdose? | Naltrexone or naloxone
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| 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
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| What is the first-line tx for a growth hormone secreting pituitary adenoma | Transphenoidal tumor resection
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| What medications should all post-MI pts receive as outpt? | Aspirin/clopidogrel, beta blocker, ACE-i/ARB, statin, aldosterone antag (spironolactone)
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| Which medication types have a proven reduction in mortality following MI? | ACE-i/ARB, statins, beta blockers
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| 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
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| What are specific labs ordered in pts suspected of MI? | Serial cardiac enzymes (trops and CKMB)
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| What is the MCC of death in pts with an acute MI? | Fatal arrhythmia (V fib)
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| 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*
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| WHich cardiac enzyme increases 2-12hr post-MI, peaks in 12-40h, and decreases in 24-72h? | CPK-MB
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| Which cardiac enzyme increases in 3h post-MI, peaks in 6h, and decreases over 7d? | Troponin (more sens and specific)
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| Whhich lab might be elevated earlier than trops (~2h)? | Myoglobin
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| 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).
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| What electrolytes should be controlled during MI and what are the cut-offs for correction? | Mg >2 and K >4. Decreases risk of arrhythmia
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| 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)
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| 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.
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| After giving your MI pt the std treatments, she becomes hypotensive. What should be done? | Stop nitroglycerin and give IVF
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| In what time frame post-MI is a pt at risk for wall rupture? | 4-5d
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| MC fatal complication within hours of an MI? | V fib (also V tach and cardiogenic shock)
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| 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.
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| Name the assoc'd coronary arter branch and EKG leads for the area of infarct: anterior wall | LAD; V2, V3, V4
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| Name the assoc'd coronary arter branch and EKG leads for the area of infarct: septal | LAD; V1, V2, V3
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| Name the assoc'd coronary arter branch and EKG leads for the area of infarct: inferior | PDA or marginal branch; II, III, aVF
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| Name the assoc'd coronary arter branch and EKG leads for the area of infarct: lateral | LAD or circumflex; I, aVL, V4, V5, V6
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| 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
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