Myocardial infarction complications: Difference between revisions
(Text replacement - " CV " to " cardiovascular ") |
(Text replacement - "*CHF" to "*CHF") |
||
| Line 40: | Line 40: | ||
===Anteroseptal MI Complications=== | ===Anteroseptal MI Complications=== | ||
*Look at V2-V4,5 | *Look at V2-V4,5 | ||
*CHF/Cardiogenic shock | *[[CHF]]/Cardiogenic shock | ||
**Large area of myocardium involved | **Large area of myocardium involved | ||
*Bradycardia | *Bradycardia | ||
Revision as of 13:34, 24 September 2016
MI Complications
LV 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 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 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 wks after MI
- Thought to be immune-mediated injury
- Listen for pericardial rub, pain/dyspnea improved with leaning forward, fever
- ECG may show pericardidits, Echo with pericardial effusion
- Treat with ASA, if > 4 wks 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 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