CAD / mechanical complications

Question 1

Ruptured mechanical complications

Answer 1

Free wall
Septal
Papillary muscle

Question 2

Unruptured mechanical complications

Answer 2

LV failure
Ischemic MR
RV infarct
LV thrombus
LV aneurysm
Dynamic LVOT obstruction

Question 3

Predictors of LV thrombus

Answer 3

Anterior MI
EF <= 35%
Apical akinesis

Question 4

Typical ischemic MR infarct

Answer 4

Inferior or inferolateral

Question 5

LV aneurysm characteristics

Answer 5

Wide neck
Cavity thin, scarred myocardium
Ratio of entry to maximum cavity ~1
As early as 5 days post MI

Question 6

LV pseudoaneurysm

Answer 6

Contained LV free wall rupture
Narrow neck
Wall thrombus and pericardium
Ratio of entry / max cavity <0.5

Question 7

Free wall rupture (uncontained)

Answer 7

Rare, 5 days
SCD
Complex effusion, tamponade

Question 8

VSD

Answer 8

Rare, high mortality
3-5 days post MI
Left to right shunt
Increased RV pressure

Question 9

VSD location

Answer 9

RCA - basal inferior septum

LAD - distal septum

Question 10

Papillary muscle rupture MI

Answer 10

Usually inferior or inferolateral STEMI

Posteromedial papillary muscle most common (RCA)

Question 11

Pathologic remodeling of LV

Answer 11

> 20% increase in ESV or EDV 6 months post MI
LVH
Spherical LV

Question 12

Poor prognostic echo parameters post MI

Answer 12

EF < 40
GLS > -14%
RV FAC < 32%, free wall strain > -22%
LAVI > 32
Restrictive filling, E/e' > 15
Ischemic MR
LV remodeling