What I learned

I went to cardiology update the other day. Amazing how much I forget, and with two maternity leaves there was alot of time to forget. For my own fun I typed some of my notes of things I need to remember. Really nobody should read this post.

• It is not so much the size of the plaque in the coronary arteries, but the instability of the plaque that determines risk for MI
• Chronic inflammatory states are a risk factor. ie. Chronic gingivitis, HIV, RA
• TNKase is a fibrolltic not a thrombotic
• Chest pain is common post sent. It is not a MI but vasospam.
• Tropolin peaks early but takes longer to normalize. Where as CK peaks late but normalizes early, thus retesting with further chest pain post MI has the ability to see if the heart has re infarcted
• Men develop collateral circulation t/o life time. Woman only develop it post menopausal thus they are an increased risk for larger MI post menopause
• AVR should be negative on a ECG. Only lead that sees inside heart. Rt arm.
• Tall narrow Twaves = increased K
• Twave changes= Ichemia, ST segment changes= Injury.
• For Q waves to be pathological they must be wide enough and deep enough.\
• Q waves mean DEAD tissue.
• Reciprocal changes- II, III, avf= I, avl, V
• Takes 1- 2 weeks for T waves to return to normal post MI
• Very important to take pain free ECG- always mark if an ECG is pain or pain free.
• Inferior MI and Posterior often go together.
• Smoking makes platelets sticky
• Takes about a month to completely enbed a stent into the vessel
• Can expect 90 seconds of pain during PCI
• Plavix loading dose can be up to 600mg
• Should be given integrilin pre PCI
• MIAnterior expect conduction problems. MI Inferior expect pump and upper GI problems.
• If inferior MI suspect to a right sided ECG to rule out right ventricular MI
• V8= 5th intercostal space
• Ecg changes are only visible during an acute event for a RVMI
• Small ECG ampitiue r/t air, fluid , fat.
• NEVER give nitro or MOS with RVMI- give fluid- 5000cc N/s.
• Give fentanyl ofr pain. Goal- do not eliminate pain but make it tolerable.
• Wellens syndrome.
• Anything below 35diastolic = Coronary arteries not perfused.