Myocardial Infaction Complications: Difference between revisions
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==Anteroseptal MI Complications== | ==MI Complications== | ||
===LV Free Wall Rupture=== | |||
*5-14 days after MI, earlier in thrombolysis pts | |||
*Leaking of fluid outside can cause tamponade | |||
**Look for JVD, pulsus paradoxus, diminished sounds | |||
*Emergent Echo if stable | |||
*Give IVF and consult CV surgery for pericardiocentesis and thoractomy | |||
===LV Aneurysm=== | |||
*Usually chronic and can persis for >6 wks after MI | |||
*Tends to occur with ant MI | |||
*Emergent Echo if stable | |||
*Treat cardiogenic shock, anticoagulate if mural thrombus | |||
*Defibrillate ventricular arrythmias | |||
===Septum rupture=== | |||
*3-7 days after MI | |||
*Blood fills RV | |||
**Listen for holosystolic murmur | |||
*Emergent Echo if stable | |||
*Reduce afterload with vasodilators and consult CV surgery | |||
*Consider IABP | |||
===Papillary muscle rupture=== | |||
*2-7 days after MI | |||
*Listen for murmur at apex | |||
*Emergent Echo if stable | |||
*Reduce afterload with vasodilators and consult CV surgery | |||
*Consider IABP | |||
==Complications Based on MI Location== | |||
===Anteroseptal MI Complications=== | |||
*Look at V2-V4,5 | *Look at V2-V4,5 | ||
*CHF/Cardiogenic shock | *CHF/Cardiogenic shock | ||
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**Bundles thru septum knocked out leading to wide complex | **Bundles thru septum knocked out leading to wide complex | ||
*Myocardial tissue rupture | *Myocardial tissue rupture | ||
*LV aneursym | |||
==Inferior MI Complications== | ===Inferior MI Complications=== | ||
*Look at II, III, aVF | *Look at II, III, aVF | ||
*Bradycardias and AV block | *Bradycardias and AV block | ||
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**MI + new murmur + CHF think valve injury | **MI + new murmur + CHF think valve injury | ||
==Right Ventricle MI Complications== | ===Right Ventricle MI Complications=== | ||
*Inf MI with ST elev III>II, ST elev V1>V2, ST dep V2 | *Inf MI with ST elev III>II, ST elev V1>V2, ST dep V2 | ||
**Lead III and V1 looks most at R side of heart | **Lead III and V1 looks most at R side of heart | ||
| Line 24: | Line 59: | ||
**Volume load | **Volume load | ||
**AVOID vasodilators, do not give SLNG | **AVOID vasodilators, do not give SLNG | ||
Revision as of 23:29, 15 May 2016
MI Complications
LV Free Wall Rupture
- 5-14 days after MI, earlier in thrombolysis pts
- Leaking of fluid outside can cause tamponade
- Look for JVD, pulsus paradoxus, diminished sounds
- Emergent Echo if stable
- Give IVF and consult CV surgery for pericardiocentesis and thoractomy
LV Aneurysm
- Usually chronic and can persis for >6 wks after MI
- Tends to occur with ant MI
- Emergent Echo if stable
- Treat cardiogenic shock, anticoagulate if mural thrombus
- Defibrillate ventricular arrythmias
Septum rupture
- 3-7 days after MI
- Blood fills RV
- Listen for holosystolic murmur
- Emergent Echo if stable
- Reduce afterload with vasodilators and consult CV surgery
- Consider IABP
Papillary muscle rupture
- 2-7 days after MI
- Listen for murmur at apex
- Emergent Echo if stable
- Reduce afterload with vasodilators and consult CV surgery
- Consider IABP
Complications Based on MI Location
Anteroseptal MI Complications
- Look at V2-V4,5
- CHF/Cardiogenic shock
- Large area of myocardium involved
- Bradycardia
- Bundles thru septum knocked out leading to wide complex
- Myocardial tissue rupture
- LV aneursym
Inferior MI Complications
- Look at II, III, aVF
- Bradycardias and AV block
- Increased vagal tone
- Sinus Node supplied by RCA in 60% of patients
- AV node supplied by RCA in 90% of patients
- Papillary muscle rupture
- RCA supplies inferior septum
- MI + new murmur + CHF think valve injury
Right Ventricle MI Complications
- Inf MI with ST elev III>II, ST elev V1>V2, ST dep V2
- Lead III and V1 looks most at R side of heart
- RV mostly supplied by RCA
- Hypotension most severe complication
- Volume load
- AVOID vasodilators, do not give SLNG