Question On Mi

In a patient with an acute MI which is the most significant dysrythmic finding?

Choices

SVT

AFIB

PVC's

Aflutter

which would you choose

For me its afib but would like your feed back

I had to look at the question pretty carefully, because at first, I thought it said "most common." But no, it's "most significant."

To me, A-Fib is not nearly as clinically significant as SVT, since SVT is, by definition, a HR over 150 BPMs. You'd want to treat that pretty quickly.

I'm just going on clinical experience here, so if anyone finds a different answer, please feel free to contradict me.

VT but it also depends on what type of MI inferior usually has bradys

I chose afib - poor atrial function therefore will lose atrial filling and you already have hypoxic venticles.

I was going there, Siri, but then I decided that since it wasn't AFib with RVR, the SVT patient would need the fastest treatment.

But like I said earlier, I'm just guessing here.

thanks for those replys they where helpful in thinking that through. I appreciate the feed back. Its nice to have people to kinda mull over issues and learn. thanks so much

Angela

But Siri, doesn't the same thing happen with A-Flutter? PVCs are also known to happen due to hypoxia. So what causes SVT? Isn't SVT a type of A-Fib? The only thing that's different about all the answers is that there is an implied rate with SVT that is not implied with any of the others.

A-Fib is usually treated with anticoagulation to prevent clots, but in the case of a s/p MI, the patient is already being anticoagulated and treated with BBs and meds that would be used for A-fibs as well as MI, is he not?

http://www.guideline.gov/summary/summary.aspx?doc_id=8362

So I agree, it's a tricky question. But interesting! I'm always willing to discuss and learn, so please understand that I'm not being argumentative here, just trying to pick apart the question a bit.

I think I'm sticking with SVT because I'd so much rather have a patient having anticoag and BB therapy with a stable A-fib (and I'm assuming that we have a rate of

I think I'm sticking with SVT because I'd so much rather have a patient having anticoag and BB therapy with a stable A-fib (and I'm assuming that we have a rate of

Now here I might be reading a tad too much into the question, I admit, so my reasoning would be that there is an implied rate with SVT which is not implied with any of the others, therefore, a more emergent problem.

Final answer.

Really.

I'm gonna go with A-flutter. Pts with chronic a-fib have MI's all the time. SVT generally is an acute problem as previously mentioned and frankly I personally havent seen it much in the instance of acute MI, though it does happen. That said pure A-flutter just dosent occur on its own that often.

More frequently though MI patients just present in plain old sinus rhythms. Sinus tach alot of the time, I give lots of Lopressor to slow them down.

RJ

*bump!*

Hoping the OP will come back and tell us what the answer is!

Thats a very bad question because there're way too many variables involved in an MI (one mi isnt the same as another mi, etc., etc.) Also, all those mentioned rhythms can affect people/mi's in different ways.

The best answer is PVC's. (unless they're RARE pvc's.) . Frequent PVC's in mi can degnerate into v-tach (3 beats is 'technically' a run). As you all know, ventricular ryhthms will drop your cardiac output much more significantly than atrial ones...AND pvc's/v-tach will/can more readily degenrate into v-fib.

And if the PVC's are multi-focal, it's even more ominous.

Yeah, PVC's are generally benign. But in the face of infarction/ischemia they need to be treated if occuring frequently.

NOW, if you said a) a-fib w/rates of 80, b)svt with rate of 200, c) rare pvc's , the answer is obviously going to be 'b' (SVT).

OR, a) a-fib w/rate of 170 in a patient w/ejection fraction of 60% b) svt w/rate 150 in a patient w/ef 60%, c) frequent pvc's in a pt w/ef 15%, palpitations, and dizziness (and mi)... i would be most concerned about c.

OR is the person holding a pressure w/the svt, a-fib, pvc's???

OR...what/where is the infarction occuring? And how extensive? ( non-qwave mi in a heart w/good ef? or did they knock out their entire LAD? Or is it left main (the widow maker?)??????????

See how there're too many variables to choose the 'right' answer with the limited info provided??

Also...know that by definition A-fib IS an SVT!!!! ('supra-ventricular' ('above the ventricles') simply means the bad rhythm is being driven by irritable atria) And is a blanket term encompassing a-fib, wpw, atrial tach, etc. Anything fast, narrow (usually too fast to determine accurately by ekg...thus the 'blanket' term)

I'm gonna go with A-flutter. Pts with chronic a-fib have MI's all the time. SVT generally is an acute problem as previously mentioned and frankly I personally havent seen it much in the instance of acute MI, though it does happen. That said pure A-flutter just dosent occur on its own that often.

More frequently though MI patients just present in plain old sinus rhythms. Sinus tach alot of the time, I give lots of Lopressor to slow them down.

RJ

I'm not picking, i just disagree with your post. First off, a-fib and a-flutter (though techinically different) are very similar and treated the same way. If fact, you can even think of a-flutter as a more 'organized' a-fib. And...because a patient has a-fib does not mean they have coronary disease...or that thay have 'mi's all the time'. You can have widely patent coronary arteries and still suffer from a-fib...for various reasons. AND keep in mind that SVT can 'be' a-fib, or a-flutter.

And...lopressor is great but if an MI patient presents in cardiogenic shock and is tachy, 'lots of lopressor' would be a bad thing.