Myocardial infarction complications
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MI Complications
Left ventricular free wall rupture
- 5-14 days after MI, earlier in thrombolysis patients
- Leaking of fluid outside can cause tamponade
- Look for JVD, pulsus paradoxus, diminished sounds
- Emergent echo if stable
- Give IVF and consult cardiovascular surgery for pericardiocentesis and thoracotomy
Left ventricular aneurysm
- Usually chronic and can persis for >6 weeks after MI
- Tends to occur with ant MI
- Emergent echo if stable
- Treat cardiogenic shock, anticoagulate if mural thrombus
- Defibrillate ventricular dysrhythmias
Septum rupture
- 3-7 days after MI
- Blood fills RV
- Listen for holosystolic murmur
- Emergent echo if stable
- Reduce afterload with vasodilators (e.g. nitroglycerin) and consult cardiovascular 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 cardiovascular surgery
- Consider IABP
Dressler's syndrome
- 1-8 weeks after MI
- Thought to be immune-mediated injury
- Listen for pericardial rub, chest pain/dyspnea improved with leaning forward, fever
- ECG may show pericarditis, Echo with pericardial effusion
- Treat with ASA, if > 4 weeks from MI can use NSAIDS or corticosteroids
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 aneurysm
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
- Myocardial infarction + 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 right side of heart
- RV mostly supplied by RCA
- Hypotensionmost severe complication
- Volume load
- AVOID vasodilators, do not give nitro