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CVS > Complications MI > Flashcards

Complications MI Flashcards

1
Q

Complications of MI

A 
Papillary muscle rupture
VSD / free wall rupture 
Heart failure 
Pericarditis
Cardiac tamponade 
Anaeurysm 
Embolization 
Organ failure 
AF, VT, VF
Mitral regurgitation 
Arrhythmia 
Decreased contractility and CO / cariogenic shock
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2
Q

What are acute complications

A 
Cardiogenic shock
Free wall rupture
Septal rupture
Papillary muscle 
VT / AF / AVRNT / AV block
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3
Q

What are sub-acute

A

Post MI Peri-carditis

Dressler

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4
Q

What are chronic

A

LV aneurysm
AF
LV thrombus
Chronic LV dysfunction

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5
Q

Mneumonic

A 
DREAD
Death
Rupture septum or papillary
Oedema / new onset HF
Arrhythmia / aneurysm
Dresslers'
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6
Q

What arrhythmia are most common

A

VT / VF
AF
AVRNT
AV block if inferior

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7
Q

When does free wall rupture occur

A

Usually 1-2 weeks post MI

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8
Q

How does it present

A 
Acute HF secondary to cardiac tamponade
Tampoande 
- Raised JVP
- Low BP 
- Pulsus paradoxus
- Diminished HS
New murmur - pan systolic
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9
Q

Who is more at risk of rupture

A

Elderly
Female
High BP
Anterior MI - LAD

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10
Q

What type of MI causes septal free wall rupture

A

Anterior MI - LAD area

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11
Q

What do you require

A

CARDIAC ARREST SITUATION
ECHO
Urgent pericardiocentesis
Surgery

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12
Q

What is cardiac tamponade

A

Blood fills around the heart

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13
Q

What are the signs of cardiac tamponade

A 
3 D's 
Distended JVP - increased 
Decreased BP 
Distant / muffled HS 
SOB
Renal failure
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14
Q

How does papillary muscle rupture present

A 
MITRAL REGURG (harsh systolic) 
Severe SOB from pulmonary oedea
Sweating / N+V from sympa activation 
Chest pain
Shock
Tachycardia
Can have pulmonary oedema and raised JVP
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15
Q

How do you Dx

A

ECHO

Angiogram

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16
Q

How do you differentiate papillary and VSD

A

Cath lab - angio
ECHO

Papillary usually inferior MI
VSD usually septal MI and present more acute

17
Q

How do you treat both ruptures

A 
IV nitrate if systolic >90
Inotrope if <90
IABP to reduce afterload - balloon 
Cardiac surgeon
Repair
18
Q

What are signs of MR

A

Murmur - harsh systolic
Worsening SOB and increased JVP
Low BP
Will lead to HF

19
Q

How do you Dx and treat

A

Vasodilator for LVF

Valve replacement

20
Q

What causes pericarditis

A

Necrotic tissue irritates pericardium

If fluid accumulates = cardiac tamponade which puts pressure on heart and reduces ventricle filling

21
Q

What does pericarditis present like

A 
Central chest pain 
Better forward
Often 1st 24 hours 
ECG changes
ECHO - look for effusion
22
Q

How do you treat pericarditis

A

NSAID

Colchicine

23
Q

What is dresslers

How do you Dx and RX

A

Autoimmune pericarditis - 1-3 week post MI
Recurretn effusion
Fever
Pericardial rub
Anaemia
Dx = ECG shows global ST elevation and T inversion, ECHO + raised inflammatory
Rx = NSAID / steroid

24
Q

What else can you get 1-3 week post MI

A

Late malignant ventricular arrhythmia

Avoid hypokalaemia

25
Q

Ventricular anuerysm
When
Complications
Rx

A 
1 month post
Persistent elevation 
LVF
Angina 
VT 
Emboli due to thrombus formation 
Anti-coagulate
Surgical
26
Q

PE

A

Due to mural thrombus

Consider anti-coagulation for 3 months post MI

27
Q

What is cardiogenic shock

A

Inadeqaute tissue perfusion to meet demands

28
Q

What causes cariogenic shock

A 
Post MI
Arrhythmia
PE
Tension pneumothorax 
Cardiac tamponade
Myocarditis
Endocarditis
Dissection
29
Q

How do you Dx cardiogenic shock

A

ECG
U+E, troponin, ABG
CXR
ECHO

30
Q

How do you Rx shock

A 
Treat MI / reversible cause 
CCU
Oxygen
Diamorphine - pain + anxiety
Plasma expander if hypo-perfused
Inotropes if overfilled - dobutamine
31
Q

How do you measure CO / monitor

A 
BP + pulse
MAP 
CVP 
ABG 
ECG - every hour until Dx made
Urine output
32
Q

What is sudden cardiac death

A

Death due to cardiac cause <6 hours from symptom onset

33
Q

What causes sudden cardiac death

A 
STEMI
CAD
CABG
Embolism
HCM
Long QT
Valvular disease
34
Q

What is the prognosis

A

Only 2% survive

Most survivors in VT or VF and can be shocked

35
Q

What are reversible causes of cardiac arrest

A 
Hypoxia
Hypovolaemia
Hyperkalaemia
Hypoglycaemia
Hypocalcaemia

Thrombosis
Tension pneumothorax
Tamponade
Toxin

36
Q

What rhythm will they be in

A

VT / VF
Asystole
Pulseless electrical activity

37
Q

How do you treat

What do you do if witnessed on cardiac
What do you do if not witnessed

A

CPR
Defib
Adrenaline if VF / VT after 3rd shock and every 5 minutes if witnessed on cardiac monitor
1 shock + adrenaline if not witnessed on cardiac monitor
Amiadarone

38
Q

If patient go into cariogenic shock after MI what do you do

A

ABCDE
Require bedside ECHO to look for any complication
Inotrope / vasopressor
Surgery

CVS (30 decks)

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