Background: Killip classification is
an independent predictor of early mortality after myocardial infarction
, and the presence of left ventricular systolic dysfunction (left ventricular ejection fraction <50%) and high Killip class predicts poor short-term prognosis.
When do you use Killip classification?
The Killip classification is widely used in
patients presenting with acute MI
for the purpose of risk stratification, as follows : Killip class I includes individuals with no clinical signs of heart failure.
What is the Forrester classification?
The stages are classified as the
Forrester Hemodynamic subsets
(Table 1). Cardiac index (CI) indicates the degree of perfusion; patients are characterized as either “warm” or “cold” depending on the presence of hypoperfusion. A CI of <2.2 L/min/m
2
warrants a classification of “cold,” indicating hypoperfusion.
What is Nstemi diagnosis?
Diagnosing an NSTEMI
NSTEMI is
diagnosed through a blood test and an ECG
. The blood test will show elevated levels of creatine kinase-myocardial band (CK-MB), troponin I, and troponin T. These markers are evidence of possible damage to the heart cells, and are typically mild compared with STEMI.
What are the types of myocardial infarction?
A heart attack is also known as a myocardial infarction. The three types of heart attacks are:
ST segment elevation myocardial infarction (STEMI) non-ST segment elevation myocardial infarction (NSTEMI)
What is cardiogenic shock?
Cardiogenic shock is
a life-threatening condition in which your heart suddenly can’t pump enough blood to meet your body’s needs
. The condition is most often caused by a severe heart attack, but not everyone who has a heart attack has cardiogenic shock. Cardiogenic shock is rare.
How is cardiogenic shock treated?
- Vasopressors. These medications are used to treat low blood pressure. …
- Inotropic agents. …
- Aspirin. …
- Antiplatelet medication. …
- Other blood-thinning medications.
What does HFpEF mean?
INTRODUCTION
Heart failure with preserved ejection fraction
(HFpEF) is a clinical syndrome in which patients have symptoms and signs of HF as the result of high ventricular filling pressure despite normal or near normal left ventricular ejection fraction (LVEF ≥50 percent) [1-5].
What is the most important drug therapy to treat ADHF?
Vasodilation. After diuretics,
intravenous vasodilators
are probably the most useful medications for the management of ADHF.
When is dobutamine used?
Dobutamine stimulates heart muscle and improves blood flow by helping the heart pump better. Dobutamine is used short-term to
treat cardiac decompensation due to weakened heart muscle
. Dobutamine is usually given after other heart medicines have been tried without success.
What is the pathophysiology of a NSTEMI?
Pathophysiology. NSTE-ACS is most commonly caused by
disruption of a coronary artery atherosclerotic plaque
, with myocardial ischemia and injury often resulting from partial or intermittent occlusion along the ischemic cascade. Other causes beyond the focus of this work include embolism and revascularization.
What is the prognosis for NSTEMI?
The five-year survival rate for NSTEMI patients
was 51%, 42% among women and 57% among men
. The five-year survival rate for STEMI patients was 77%, 68% among women and 80% among men.
What is NSTEMI?
Non-ST-elevation myocardial infarction
(NSTEMI) is a type of [“heart attack”: link to new heart attack copy] involving partial blockage of one of the coronary arteries, causing reduced flow of oxygen-rich blood to the heart muscle.
How are myocardial infarction classified?
The type of acute myocardial infarction also was categorized as
ST-elevation myocardial infarction
or non–ST-elevation myocardial infarction as defined in the universal definition. Patients with new (or presumably new) left bundle branch block were designated as having an ST-elevation myocardial infarction.
What is the most common type of myocardial infarction?
Type 2 MI
is the most common type of MI encountered in clinical settings in which is there is demand-supply mismatch resulting in myocardial ischemia. This demand supply mismatch can be due to multiple reasons including but not limited to presence of a fixed stable coronary obstruction, tachycardia, hypoxia or stress.
What are the main causes of myocardial infarction?
A heart attack occurs when one of the heart’s coronary arteries is blocked suddenly or has extremely slow blood flow. A heart attack also is called a myocardial infarction. The usual cause of sudden blockage in a coronary artery is
the formation of a blood clot (thrombus)
.
Why does cardiogenic shock happen?
Cardiogenic shock is a serious condition that occurs
when your heart cannot pump enough blood and oxygen to the brain, kidneys, and other vital organs
. Cardiogenic shock is considered a medical emergency and should be treated immediately. The most common cause of cardiogenic shock is a heart attack.
Which medication class should be prescribed to patients with acute ischemic cardiogenic shock?
Medication Summary
Sympathomimetic amines with both alpha- and beta-adrenergic effects
are indicated for persons with cardiogenic shock. Dopamine and dobutamine are the drugs of choice to improve cardiac contractility, with dopamine the preferred agent in patients with hypotension.
What is the pathophysiology of cardiogenic shock?
The pathophysiology of cardiogenic shock involves a vicious spiral circle:
ischemia causes myocardial dysfunction
, which in turn aggravates myocardial ischemia. Myocardial stunning and/or hibernating myocardium can enhance myocardial dysfunction, thus, worsening the cardiogenic shock.
What is the difference between cardiogenic and hypovolemic shock?
Cardiogenic shock (due
to heart problems
) Hypovolemic shock (caused by too little blood volume)
Why is dopamine used in cardiogenic shock?
Dopamine possesses a variety of useful pharmacologic properties. It functions as an a-adrenergic agonist, causing vasoconstriction of peripheral capacitance and resistance vessels; it also is a β-adrenergic agonist, producing
an increase in cardiac rate
and an augmentation of myocardial contractility.
Is cardiogenic shock the same as heart failure?
Cardiogenic shock is a
medical emergency
that occurs when the heart cannot provide oxygen-rich blood to the brain and other organs. It occurs most commonly due to heart attack or heart failure, but it can also be due to a complication from other conditions or procedures.
What are the characteristics of HFpEF?
“HF with preserved EF (HFPEF)” has been defined as the presence of typical HF symptoms and
signs with an EF of more than 40% or 50%
. Prior studies demonstrated that patients with HFPEF are older, more often female, and have hypertension compared to those with reduced EF [1], [2], [3], [4].
What is preserved LV function?
The clinical syndrome of heart failure with preserved left ventricular function (LVF) also defined as HF with a normal ejection
fraction
, is a common condition in patients with HF and has emerged as a serious clinical problem.
What is the difference between HFrEF and HFpEF?
HFrEF, mostly occurs in male patients and is the
consequence of cardiomyocyte loss
. In contrast, HFpEF is often diagnosed in elderly female patients, who suffer from (a cluster of) non-cardiac comorbidities, such as hypertension, T2DM, stroke, anaemia, pulmonary disease, liver disease, sleep apnoea, gout, and cancer.
What is the significance of the BNP in a cardiac patient?
BNP
helps the body compensate for congestive heart failure
(CHF); measurements of BNP help doctors diagnose and treat this serious condition. Congestive heart failure results when the heart muscle is weakened. The most common causes are coronary artery disease and hypertension.
What is the major clinical use of dobutamine?
Dobutamine is used to
treat acute but potentially reversible heart failure
, such as which occurs during cardiac surgery or in cases of septic or cardiogenic shock, on the basis of its positive inotropic action. Dobutamine can be used in cases of congestive heart failure to increase cardiac output.
How does dobutamine affect the heart?
Clinically, dobutamine
increases cardiac output by selectively augmenting stroke volume
, and this is associated with a decrease in total peripheral vascular resistance that is mediated, in part, by reflex withdrawal of sympathetic tone to the vasculature.
How does dobutamine work on the heart?
Dobutamine
directly stimulates beta-1 receptors of the heart to increase myocardial contractility and stroke volume
, resulting in increased cardiac output. In human urine, the major excretion products are the conjugates of dobutamine and 3-O-methyl dobutamine.
What is ADHF in heart failure?
Acute decompensated heart failure
(ADHF) is a clinical syndrome of new or worsening signs and symptoms of HF, often leading to hospitalization or a visit to the emergency department. Patients with ADHF represent a heterogeneous population with high post-discharge readmission rates [1-13].
Which of the following treatments are used as first line treatments of ADHF in the ED?
Intravenous loop diuretics
are the primary therapy in most patients admitted with ADHF and as noted above, improve symptoms predominantly by decreasing venous congestion and volume overload.
What is difference between STEMI and NSTEMI?
If there is a pattern known as ST-elevation on the EKG, this is called a STEMI, short for ST elevation myocardial infarction. If
there is elevation of the blood markers suggesting heart damage
, but no ST elevation seen on the EKG tracing, this is known as a NSTEMI.
What is a Type 2 NSTEMI?
Type 2 NSTEMI is defined as
myocardial ischemia resulting from mismatched myocardial oxygen supply and demand
that is not related to unstable coronary artery disease (CAD).
Is troponin elevated in NSTEMI?
However, an elevated troponin along with other appropriate clinical and laboratory evidence
raises the probability that the diagnosis is NSTEMI
. The higher the troponin value, the greater the probability that the final diagnosis will be MI. It must be stressed that the data must be consistent.
Why are stemi and NSTEMI treated differently?
Equally important, NSTEMI heart attacks are caused by
different types of blood clots than STEMI
heart attacks, with differing amounts of clotting proteins and platelet blood cells. Therefore, the treatment of NSTEMI heart attacks differs from the treatment of STEMI heart attacks.
What genes are associated with NSTEMI?
- Perttu P. Salo , …
- Satu Vaara, …
- Johannes Kettunen, …
- Matti Pirinen, …
- Antti-Pekka Sarin, …
- Heikki Huikuri, …
- Pekka J. …
- Markku Eskola,
Why are Fibrinolytics not used in NSTEMI?
In NSTEMI the blood flow is present but limited by stenosis. In NSTEMI,
thrombolytics must be avoided as there is no clear benefit of their use
. If the condition stays stable a cardiac stress test may be offered, and if needed subsequent revascularization will be carried out to restore a normal blood flow.
Is NSTEMI ischemia?
This is explained by the fact that NSTEMI and unstable angina are caused by partial (incomplete) coronary artery occlusions; a partial occlusion results in a reduction of coronary blood flow and this causes
subendocardial ischemia
(i.e ischemia that only affects the subendocardium).
What complication is responsible for the most deaths following acute myocardial infarction?
Ventricular free wall rupture
.
VFWR
is the most serious complication of AMI. VFWR is usually associated with large transmural infarctions and antecedent infarct expansion. It is the most common cause of death, second only to LV failure, and it accounts for 15-30% of the deaths associated with AMI.
What is the death rate of myocardial infarction?
Acute myocardial infarction (MI) is associated with a
30% mortality rate
; about 50% of the deaths occur prior to arrival at the hospital. An additional 5-10% of survivors die within the first year after their myocardial infarction.
Why are unstable angina and MI classified as ACS?
Unstable angina is considered to be an
ACS in which there is myocardial ischemia without detectable myocardial necrosis
(ie, cardiac biomarkers of myocardial necrosis—such as creatine kinase MB isozyme, troponin, myoglobin—are not released into the circulation).
What myocardial means?
:
the middle muscular layer of the heart wall
. Other Words from myocardium Example Sentences Learn More About myocardium.
What is type1 and type2 mi?
Type 1 MI is
a primary coronary arterial event attributable
to atherothrombotic plaque rupture or erosion. Type 2 MI occurs secondary to an acute imbalance in myocardial oxygen supply and demand without atherothrombosis.
