Myocardial Infarction, Flash Pulmonary Edema, and Cardiogenic Shock
Myocardial Infarction- irreversible myocardial necrosis that results from an abrupt decrease or total
cessation or coronary blood flow to a specific area of the myocardium
We call it an Acute MI, the non-geniuses call it a heart attack
STEMI- CLOT st elevation
NSTEMI- PLAQUE non-st elevated
treat with MONA (O2, Nitrogen, Morphine, Aspirin, in order)
MOA- plaque rupture (breaks off, floats down and blocks blood flow)
new coronary artery thrombosis (new clot, could float down or just start there)
coronary artery spasm (clamping down causes decreased blood flow, Prinz angina)
Clinical Manifestations
tachycardia/bradycardia, Dec CO Crackles Dec blood flow (restless, confusion,
anxiety,agitation, denial, anger)
normotension/HYPOtension Pulmonary edema Dec urine output
Diminished heart sounds (S1) Air hunger/Orthopnea Slow cap refill/Dec pulses
S3 (failure) or S4 (HTN) Frothy Sputum
Systolic murmur
Pathophysiology
Muscle Insult Electrical ECG
Zone of Infarction Dead, Necrosis No Conduction/Contract Pathological Q-wave
Zone of Injury Potentially Viable Incomplete Repolarization Elevated ST-segment
Zone of Ischemia Viable Save This Muscle!!! T-wave inversion
Transmural MI- full thickness
-all three layers, Endocardium (inside, epitheial tissue)
Myocardium (middle, thick working muscle)
Epicardium (outside, fibrous covering)
no contraction, conduction so significant ECG changes....Q WAVE MI (check mark)
12-Lead ECG Changes
Depolarization: Q-wave
Repolarization: Elevated ST-segment, Q-wave, T-wave inversion
Coronaries:
, Anterior Wall MI
worst type, LAD...called the widowmaker, supplies the Left Ventricle
V1, V2, V3, V4
Failure to pump forward, goes back into lungs (LV pump failure=cardiogenic shock=death)
s/s hypotension, tachycardia, pink frothy sputum
Left Lateral Wall MI
least important, Circumflex artery
I, aVL, V5, V6
usually seen in combo with other areas, mainly plaques
Inferior Wall MI
usually conduction disturbances, RCA
II, III, aVf
s/s bradycardia (SA node) , heart block (AV node)
Right Ventricular MI
hard to pick up, proximal section of RCA...reverse 12 lead to pick up
right ventricle/inferior wall...if massive, cannot get blood to LV=cardiogenic shock
s/s JVD, edema, liver enlargement
RV takes returning blood, so if it fails 1. blood stays in body, increasing venous pressure/edema
2. doesnt get blood through heart, nothing for LV to pump
Posterior Wall MI
RCA (dominant) or Circumflex...Tall R-waves in V1/V2
Fibrinolytic Therapy
for STEMI (because stemi is clots)...all of the -ASE meds
lysis of acute thrombus, recanalizing the obstructed artery...prevent further clots afterwards
Recent Onset of Chest Pain...>30 minutes and <12 hours and Nitro didnt work
ST Elevation
Exclusion-stable clots that could be disrupted from surgery/trauma, unstable angina, NSTEMI
Reperfusion
ischemic chest pain goes away suddenly...infarcting muscle gets the needed blood
Could get dysrhythmias (PVC, Bradycardia, Heart Block, V-tach, V-fib)...treat them!
ST Segment goes to baseline. Cardiac enzymes go up with damage:
Normal Level 1st Detectable Level Duration
CK-MB 30-170 u/L 4-6 hours 3 days
Troponin T <0.2 3-5 hours 14-21 days
Myocardial Infarction- irreversible myocardial necrosis that results from an abrupt decrease or total
cessation or coronary blood flow to a specific area of the myocardium
We call it an Acute MI, the non-geniuses call it a heart attack
STEMI- CLOT st elevation
NSTEMI- PLAQUE non-st elevated
treat with MONA (O2, Nitrogen, Morphine, Aspirin, in order)
MOA- plaque rupture (breaks off, floats down and blocks blood flow)
new coronary artery thrombosis (new clot, could float down or just start there)
coronary artery spasm (clamping down causes decreased blood flow, Prinz angina)
Clinical Manifestations
tachycardia/bradycardia, Dec CO Crackles Dec blood flow (restless, confusion,
anxiety,agitation, denial, anger)
normotension/HYPOtension Pulmonary edema Dec urine output
Diminished heart sounds (S1) Air hunger/Orthopnea Slow cap refill/Dec pulses
S3 (failure) or S4 (HTN) Frothy Sputum
Systolic murmur
Pathophysiology
Muscle Insult Electrical ECG
Zone of Infarction Dead, Necrosis No Conduction/Contract Pathological Q-wave
Zone of Injury Potentially Viable Incomplete Repolarization Elevated ST-segment
Zone of Ischemia Viable Save This Muscle!!! T-wave inversion
Transmural MI- full thickness
-all three layers, Endocardium (inside, epitheial tissue)
Myocardium (middle, thick working muscle)
Epicardium (outside, fibrous covering)
no contraction, conduction so significant ECG changes....Q WAVE MI (check mark)
12-Lead ECG Changes
Depolarization: Q-wave
Repolarization: Elevated ST-segment, Q-wave, T-wave inversion
Coronaries:
, Anterior Wall MI
worst type, LAD...called the widowmaker, supplies the Left Ventricle
V1, V2, V3, V4
Failure to pump forward, goes back into lungs (LV pump failure=cardiogenic shock=death)
s/s hypotension, tachycardia, pink frothy sputum
Left Lateral Wall MI
least important, Circumflex artery
I, aVL, V5, V6
usually seen in combo with other areas, mainly plaques
Inferior Wall MI
usually conduction disturbances, RCA
II, III, aVf
s/s bradycardia (SA node) , heart block (AV node)
Right Ventricular MI
hard to pick up, proximal section of RCA...reverse 12 lead to pick up
right ventricle/inferior wall...if massive, cannot get blood to LV=cardiogenic shock
s/s JVD, edema, liver enlargement
RV takes returning blood, so if it fails 1. blood stays in body, increasing venous pressure/edema
2. doesnt get blood through heart, nothing for LV to pump
Posterior Wall MI
RCA (dominant) or Circumflex...Tall R-waves in V1/V2
Fibrinolytic Therapy
for STEMI (because stemi is clots)...all of the -ASE meds
lysis of acute thrombus, recanalizing the obstructed artery...prevent further clots afterwards
Recent Onset of Chest Pain...>30 minutes and <12 hours and Nitro didnt work
ST Elevation
Exclusion-stable clots that could be disrupted from surgery/trauma, unstable angina, NSTEMI
Reperfusion
ischemic chest pain goes away suddenly...infarcting muscle gets the needed blood
Could get dysrhythmias (PVC, Bradycardia, Heart Block, V-tach, V-fib)...treat them!
ST Segment goes to baseline. Cardiac enzymes go up with damage:
Normal Level 1st Detectable Level Duration
CK-MB 30-170 u/L 4-6 hours 3 days
Troponin T <0.2 3-5 hours 14-21 days
