Inf wall MI..Imp question for smart people.. - sdrzv11

[ArchivalUser]

KP qbank
55y man with chest pain in ER has bp 90/60 and HR 65 ,recieved oxygen,aspirin ,morphine has EKG with Twave in lead II ,III and avF .KG also shows pauses of 2-3 sec.Next step

1.atropine 2.enoxaprin

UW
50Yman with chest pain ,BP 85/52,HR 34 ,RR16 has STelevation in II, III,avF .has oxy,aspirin,morphine next best initial step.

1.iv ns 2.atropine 3.dopamine

I know enoxaprin is given inNSTEMI..BUT KP also says as it is Inf wall MI there is no need to give atropine
while in this question of uw they r giving atropine bc acc. to them severe symptomatic bradycardia must be treated appropriately with atropine....also uw says iv nss and dopamine r given to improve hypotension but here hypotension is bc of severe bradycardia

so should we use atropine in INF WALL MI or not
any idea dear friends :-)

[ArchivalUser]

UW Qs answer is 1 IV NS since its inferior infart( rt ven infart) hypovolemia shud be treated with IV NS.

[ArchivalUser]

I believe hr of 34 indicates complete heart block which mandates atropine & most likely his hypotension is secondary to bradycardia so atropine should be given, whereas in first patient with heart rate of 65 does not immediately warrant atropine. It's just my logic, details to be checked.

[ArchivalUser]

Id IV NS does not work the 2nd option wud be dopamine.

Kaplan qs answer wud be enoxaparin

[ArchivalUser]

@dramitkaushal1 ..i think ur logic is correct ...so basically we will pick ans based on the severity of Bradycardia..this is wht i think too..
:-)
@pacemaker..i think the ans in uw was atropine as far as i remeber bc i added that q in my notebook...
anyone else... :-)

[ArchivalUser]

ok thanks.

[ArchivalUser]

Just did this q.

definite treatment is thromolytics/PCI but pt had recent abdominal surgery so thrombolytics were contraindicated. THe answer was transvenous pacing/atropine as a bridge to PCI.

[ArchivalUser]

what i do ...........

if BP is low but HR is okay .....> IV fliuds
if BP is okay but HR is low .....> atropine

if both are low ....> atropine and fluids first line , if does not responce with first line and HR is very low < 40 pace maker is second option .

[ArchivalUser]

Thank you so much all of you... :-)