The pathophysiology of acute MI is plaque rupture. List and describe the role of platelets, coagulation cascade and vasoactive agents at the site of rupture.
- The student can recognize the history consistent with myocardial infarction.
- Graph on a time line extending the rise, peak and fall for each of the cardiac enzymes:
- Troponin I or T
- Center in the diagnostic algorithm for acute MI is the 12 lead ECG. Interpret the 7 EKG’s at the back of this lession.
- Define the treatment algorithm for ST elevation and ST depression.
- Describe the activity and treatment for an uncomplicated acute MI with a post MI LVEF of 35% from day 2 through discharge.
- Take and record the directed detailed history to allow the rapid and effective triage of patients presenting with an acute MI. The student must be able to exclude life-threatening conditions that can mimic acute MI, specifically aortic dissection.
- Recognize Acute ST elevation indicative of acute MI and differentiate it from pericarditis and early repolarization.
- Treat the acute MI patient with aspirin, beta blockers and fibrinolytics.
- Perform the physical exam required to recognize
- cardiogenic shock
- Post myocardial complications of VSD or papillary muscle rupture
- Post MI pericarditis
- Post MI CHF
- Recognize telemetry tracing of ventricular fibrillation, ventricular tachycardia, and atrial fibrillation
- Perform the needed pre-discharge testing for the post MI patient
The student should develop a calm , professional bedside manner in order to effectively care for the acute MI patient and his/her family. Rapid decisions need to be made in order to provide optimal care.
The patient will probably never feel more vulnerable than during the early days post MI and the student has to be a source of information and education for the patient and family in order to ensure the best outcome.
- Harrison's Principles of Internal Medicine 15th Edition, pages 1386-1399