Complications MI Flashcards
Complications of MI
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
What are acute complications
Cardiogenic shock Free wall rupture Septal rupture Papillary muscle VT / AF / AVRNT / AV block
What are sub-acute
Post MI Peri-carditis
Dressler
What are chronic
LV aneurysm
AF
LV thrombus
Chronic LV dysfunction
Mneumonic
DREAD Death Rupture septum or papillary Oedema / new onset HF Arrhythmia / aneurysm Dresslers'
What arrhythmia are most common
VT / VF
AF
AVRNT
AV block if inferior
When does free wall rupture occur
Usually 1-2 weeks post MI
How does it present
Acute HF secondary to cardiac tamponade Tampoande - Raised JVP - Low BP - Pulsus paradoxus - Diminished HS New murmur - pan systolic
Who is more at risk of rupture
Elderly
Female
High BP
Anterior MI - LAD
What type of MI causes septal free wall rupture
Anterior MI - LAD area
What do you require
CARDIAC ARREST SITUATION
ECHO
Urgent pericardiocentesis
Surgery
What is cardiac tamponade
Blood fills around the heart
What are the signs of cardiac tamponade
3 D's Distended JVP - increased Decreased BP Distant / muffled HS SOB Renal failure
How does papillary muscle rupture present
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
How do you Dx
ECHO
Angiogram
How do you differentiate papillary and VSD
Cath lab - angio
ECHO
Papillary usually inferior MI
VSD usually septal MI and present more acute
How do you treat both ruptures
IV nitrate if systolic >90 Inotrope if <90 IABP to reduce afterload - balloon Cardiac surgeon Repair
What are signs of MR
Murmur - harsh systolic
Worsening SOB and increased JVP
Low BP
Will lead to HF
How do you Dx and treat
Vasodilator for LVF
Valve replacement
What causes pericarditis
Necrotic tissue irritates pericardium
If fluid accumulates = cardiac tamponade which puts pressure on heart and reduces ventricle filling
What does pericarditis present like
Central chest pain Better forward Often 1st 24 hours ECG changes ECHO - look for effusion
How do you treat pericarditis
NSAID
Colchicine
What is dresslers
How do you Dx and RX
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
What else can you get 1-3 week post MI
Late malignant ventricular arrhythmia
Avoid hypokalaemia
Ventricular anuerysm
When
Complications
Rx
1 month post Persistent elevation LVF Angina VT Emboli due to thrombus formation Anti-coagulate Surgical
PE
Due to mural thrombus
Consider anti-coagulation for 3 months post MI
What is cardiogenic shock
Inadeqaute tissue perfusion to meet demands
What causes cariogenic shock
Post MI Arrhythmia PE Tension pneumothorax Cardiac tamponade Myocarditis Endocarditis Dissection
How do you Dx cardiogenic shock
ECG
U+E, troponin, ABG
CXR
ECHO
How do you Rx shock
Treat MI / reversible cause CCU Oxygen Diamorphine - pain + anxiety Plasma expander if hypo-perfused Inotropes if overfilled - dobutamine
How do you measure CO / monitor
BP + pulse MAP CVP ABG ECG - every hour until Dx made Urine output
What is sudden cardiac death
Death due to cardiac cause <6 hours from symptom onset
What causes sudden cardiac death
STEMI CAD CABG Embolism HCM Long QT Valvular disease
What is the prognosis
Only 2% survive
Most survivors in VT or VF and can be shocked
What are reversible causes of cardiac arrest
Hypoxia Hypovolaemia Hyperkalaemia Hypoglycaemia Hypocalcaemia
Thrombosis
Tension pneumothorax
Tamponade
Toxin
What rhythm will they be in
VT / VF
Asystole
Pulseless electrical activity
How do you treat
What do you do if witnessed on cardiac
What do you do if not witnessed
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
If patient go into cariogenic shock after MI what do you do
ABCDE
Require bedside ECHO to look for any complication
Inotrope / vasopressor
Surgery
