Myocardial infarction complications: Difference between revisions
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===Left ventricular free wall rupture=== | ===Left ventricular free wall rupture=== | ||
*5-14 days after MI, earlier in thrombolysis patients | *5-14 days after MI, earlier in thrombolysis patients | ||
*Leaking of fluid outside can cause tamponade | *Leaking of fluid outside can cause [[tamponade]] | ||
**Look for JVD, pulsus paradoxus, diminished sounds | **Look for JVD, pulsus paradoxus, diminished sounds | ||
*Emergent Echo if stable | *Emergent Echo if stable | ||
*Give IVF and consult cardiovascular surgery for pericardiocentesis and | *Give [[IVF]] and consult cardiovascular surgery for [[pericardiocentesis][ and thoracotomy | ||
===[[Left ventricular aneurysm]]=== | ===[[Left ventricular aneurysm]]=== | ||
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*Tends to occur with ant MI | *Tends to occur with ant MI | ||
*Emergent Echo if stable | *Emergent Echo if stable | ||
*Treat cardiogenic shock, anticoagulate if mural thrombus | *Treat [[cardiogenic shock]], [[anticoagulant|anticoagulate]] if mural thrombus | ||
*Defibrillate ventricular | *Defibrillate [[ventricular dysrhythmias]] | ||
===Septum rupture=== | ===Septum rupture=== | ||
*3-7 days after MI | *3-7 days after MI | ||
*Blood fills RV | *Blood fills RV | ||
**Listen for holosystolic murmur | **Listen for holosystolic [[murmur]] | ||
*Emergent Echo if stable | *Emergent Echo if stable | ||
*Reduce afterload with vasodilators | *Reduce afterload with vasodilators (e.g. nitrand consult cardiovascular surgery | ||
*Consider IABP | *Consider IABP | ||
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*1-8 wks after MI | *1-8 wks after MI | ||
*Thought to be immune-mediated injury | *Thought to be immune-mediated injury | ||
*Listen for pericardial rub, pain/dyspnea improved with leaning forward, fever | *Listen for pericardial rub, [[chest pain]]/[[dyspnea]] improved with leaning forward, [[fever]] | ||
*[[ECG]] may show | *[[ECG]] may show [[pericarditis]], Echo with [[pericardial effusion]] | ||
*Treat with ASA, if > 4 wks from MI can use NSAIDS or corticosteroids | *Treat with [[ASA]], if > 4 wks from MI can use [[NSAIDS]] or [[corticosteroids]] | ||
==Complications Based on MI Location== | ==Complications Based on MI Location== | ||
===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]] | ||
**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 | *LV aneurysm | ||
===Inferior MI Complications=== | ===Inferior MI Complications=== | ||
*Look at II, III, aVF | *Look at II, III, aVF | ||
*Bradycardias and AV block | *[[Bradycardias]] and [[AV block]] | ||
**Increased vagal tone | **Increased vagal tone | ||
**Sinus Node supplied by RCA in 60% of patients | **Sinus Node supplied by RCA in 60% of patients | ||
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*[[Hypotension]]most severe complication | *[[Hypotension]]most severe complication | ||
**Volume load | **Volume load | ||
**AVOID vasodilators, do not give | **AVOID vasodilators, do ''not]] give [[nitro]] | ||
==See Also== | ==See Also== | ||
Revision as of 19:42, 27 January 2019
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 wks 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. 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
- 1-8 wks 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 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 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