Myocardial infarction complications

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

Septum rupture

  • 3-7 days after MI
  • Blood fills RV
    • Listen for holosystolic murmur
  • Emergent Echo if stable
  • Reduce afterload with vasodilators (e.g. nitrand 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

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

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

See Also

External Links

Refences

Authors:

Neil Young