ischemic complications
what is infarct expansion?
thinning, stretching & dilation of the damaged area without adding new dead muscle
what are the mechanical complications?
papillary muscle rupture, free wall rupture, ventricular septal rupture, & ventricular aneurysms
what are acute complications of MI?
pericardial effusion, thrombus, RV infarction, acute MR, free wall rupture, cardiogenic shock
what causes ACS?
disruption of an unstable atherosclerotic plaque with associated partial or complete coronary artery thrombosis
T or F: large accumulations are common and are suspect to rupture
FALSE, they are rare but are suspect to rupture
what is infarct extension?
new heart muscle death in same vascular territory as original heart attack often occurring from poor blood or re-occlusion which increases the necrotic tissue mass
what does a papillary muscle rupture cause?
mobile mass in LV prolapsing into LA & severe MR with eccentric or broad jet
LV cavity & mitral annulus dilation, papillary muscle dysfunction, papillary muscle rupture, acute systolic anterior motion of MV
T or F: patients with ACS are not always symptomatic
FALSE - they are always symptomatic
what is a typical electrical complication to have with acute MI?
arrhythmias
what is reinfarction?
acute MI that occurs within 28 days of original MI & may require urgent revascularization
what does a ventricular aneurysm occur from? what are the types?
consequence of infarct expansion, true and pseudoaneurysm (false)
what is an ischemic cardiomyopathy?
Dilated ventricle with severe diffuse LV dysfunction with areas of fibrosis & scarring
classifications of ACS, & which is the most severe?
unstable angina, NSTEMI, STEMI (most severe)
what causes thrombus formation? how does thrombus formation relate to MI?
factors that influence clotting & stagnation of blood flow
In the event of an MI, the necrotic wall may allow for blood to stagnate & a thrombus can form at the site of poor LV contraction
what is ventricular remodeling? what happens?
change in geometry of ventricle due to infarct extension & expansion that takes about 6 weeks post MI
increase in ventricular size and dilation begins early
what is the Dor myoplasty procedure?
a way to control an aneurysm with a patch placed across area of the aneurysm to separate it from functional LV walls
what is cardiogenic shock? what are the causes?
when the heart can no longer maintain a CO high enough to supply the body with enough O2
LV infarct, RV MI, mechanical complications of MI (VSD, tamponade)
what is the treatment for STEMI?
emergent catheterization and percutaneous intervention with a door-to-balloon time of 90 minutes
what is thrombus embolization and why is it bad?
what is chronic remodeling?
ventricle gradually alters size & geometry due to adverse effects of MI; usually results in dilation & globally reduced contraction with reduced EF as well as the localized infarct zone being surrounded by dysfunctional border zone
what is a contained rupture? why can this be bad?
false aneurysm; can spontaneously rupture which is fatal
T or F: a patient with an acute infarct and went from an EF of 65% to 30% is in cardiogenic shock
TRUE
ACS type is classified based on what
patient history, symptoms, presenting ECG, troponin levels
friction rub occurs from pericarditis. what can aggravate that symptom?
movement and inspiration