Understand concepts in medicine so you can solve problems ...
134Recent MI?+12h: unresponsive and dies! Likely d/t Vfib Tx: chest compressions, defibrillation, epinephrine + amiodarone (see ACLS podcast)Epinephrine: used for arrythmias, anaphylactic shock+bilateral crackles, profoundly hypotensive: cardiogenic shockMI = death of cardiac myocytes --> inadequate contractilityHeart volume is full bc can't pump outEnd-diastolic volumeincreasedEnd-diastolic pressureincreasedStroke volumedecreasedEnd-systolic volumeincreasedSBPDecreasedCODecreasedLA pressure (surrogate for PCWP)IncreasedSVR IncreasedCV pressure (surrogate for RA)Increased ^^^Pulmonary edema d/t cardiogenic shockVs. ARDS (increased pulmonary permeability): normal PCWP (<18)+flash mitral regurgitation d/t papillary muscle rupture --> florid backflow of blood+holosystolic murmur @ LLSB: intraventricular septal rupture+severe abdominal pain: acute mesenteric ischemia"heart is quivering and not contracting appropriately, causing/flicking off a clot"Vs chronic mesenteric ischemia: pain after eating, "angina of the bowel"+severe leg pain: acute limb ischemiaVs chronic = peripheral arterial disease+few days, BP 80/50, JVD, tall + tiny QRS (Beck's triad): ventricular free wall ruptureBlood pools in pericardial space causing cardiac tamponadeSx: distant heart sounds, electrical alternans (heart "dancing" in some kind of fluid -- recorded when comes close to chest wall), low-voltage EKG (also seen in deposition i.e. amyloid)+revascularization, chest pain: reinfarction? --> dx with CK-MB+PCI, rising Cr, "blue-toe syndrome", mat-like rash "livedo reticularis" on LE? Cholesterol embolization+few days, chest pain, scratchy sound in systole + diastole? Post-infarction pericarditisWidespread ST elevation, PR depression+weeks, chest pain, scratchy sound in systole + diastole? Dressler's syndrome (autoimmune pericarditis)Ddx of pericarditis: recent viral syndrome, renal failure/uremia, radiation therapy to chest (also a huge RF for thyroid CA!)+chest pain radiating to jaw, nitroglycerin leading to hypotension: RCA infarct (pre-load dependent!)EKG: II, III, AVFTx: fluids *steroids are not generally helpful in MI bc prevent wound healing* ................
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