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Common Congenital Heart Lesions - page 41 / 126

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Acute MI

  • Signs & Symptoms

Characteristic pain:

  • Result of NO & adenosine’s actions on afferent nerve endings

  • Resembles angina qualitatively, but is more sever, longer in duration, & radiates more widely

  • Doesn’t wane with rest

  • Responds very little to sublingual nitroglycerin

  • Referred to the C7-T4 dermatome regionsÆreferred pain to the neck, shoulders, & arms

  • May elicit a “feeling of doom”

*Note however, that 25% of patients may be asymptomatic…this is especially common among diabetics with peripheral neuropathy

Sympathetic effect:

  • Result of pain & baroreceptor unloading (if hypotension is present)

  • Cool, clammy skin (b/c of vasoconstriction)

  • Diaphoresis (AKA “sweating”)

  • Tachycardia

Parasympathetic effect:

  • Nausea & vomiting

  • Weakness

LV systolic & diastolic dysfunctionÆimpaired contractilityÆreduced SVÆincreased LVEDV & LVEDPÆLA backflowÆpulmonary venous backflowÆpulmonary congestionÆdecreased lung complianceÆJ receptor activationÆrapid, shallow breathing & feelings of dyspnea

Physical Exam Findings:

  • S4 because of LA contraction into a stiffened LV

  • S3 because of volume overload & possible MR (b/c of LV hypertrophy)

  • Pansystolic (Holosystolic) murmur b/c of resulting MR or VSD

  • Pericardial friction rub b/c of resulting pericarditis

*Note however, that all patients presenting with chest pain won’t have UA or an acute MI! You must be aware of such conditions and their differentiating features! REFER TO TABLE 7.4 (p. 169)

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