Complications of Acute Myocardial Infarction Flashcards
Electrical Complications of MI
- Bradys
- Bundle branch blocks
- Various degrees of heart block
Electrical Complications of MI - Sinus Bradycardia
- < 60 bpm
-
Usually occurs early
> 48hrs after corcery artery MI
> inferior wall MI; R coronary artery, supplies blood to SA & AV node -
If symptomatic: Atropine
> 0.5-1.0mg IV push, repeat every 3-5mins to a max dose of 0.03mg/kg
Electrical Complications of MI - Sinus Tachycardia
- HR > 100 bpm
- Seen early
- Anterior wall MI (left coronary artery)
- Treat underlying cause to dcr myocardial oxygen consumption
- Maintain cardiac output
Electrical Complications of MI - Atrial Dysrhythmias
-
Premature artial contractions (PACs)
> bening unless frequent, can go into afib -
Atrial fibrillation
> can dcr cardiac output by 20%
> treatment goal is rhythm & rate control
Electrical Complications of MI - Atrioventricular (AV) Heart Block
- Usually occurs during MI
-
Inferior wall MI
> R coronary artery supplies blood to R AV node -
Treatment for symptomatic AV blocks: transcutaneous or transvenous pacemaker
> greater mortality rate
Electrical Complications of MI - Ventricular Dysrhythmias
-
Premature Ventricular Contractions (PVCs)
> can occur anytime, most likely to occur w/in first 24hrs of MI
> Pharm treated if PVCs are: more than 6 per min, closely coupled, multiform shapes, occur in bursts or 3+
> Frequent PVCs incrs the risk of sustanice vtach
> Treatment: O2 to dcr myocardial hypoxia, correct acid-base balance - Ventricular fibrillation
- Medications: beta blockers
Mechanical Complications of MI - Ventricular Aneurism
- A non-contractile, thinned LV wall tht results from an acute transmural infarction
- Most commonly seen w/ left anterior descending artery (LAD)
-
Usually a late complication
> WBCs weaken area of heart when trying to clean up after MI
Mechanical Complications of MI - Ventricular Aneurism
prevention
complications
symptoms
-
Prevention
> early reperfusion -
Complications
> acute heart failure
> systemic emboli
> angina
> VT -
Symptoms
> correlate w/ the complications
> know HF symps
Left Ventricular Failure - Signs
- Tachypnea
- Tachycardia
- Cough
- Bibsilar crackles
- Gallop rhythms (S3 & S4)
- Incrd pulm artery pressures
- Hemoptysis
- Cyanosis
- Pulm edema
Left Ventricular Failure - Symptoms
- Fatigue
- Dyspnea
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Nocturia
Right Ventricular Failure - Signs
- Peripheral edema
- Hepatomegaly
- Splenomegaly
- Hepatojugular reflux
- Ascites
- Jugular central venous pressure
- Pulm HTN
Right Ventricular Failure - Symptoms
- Weakness
- Anorexia
- Indigestion
- Weight gain
- Mental changes
Mechanical Complications of MI - Ventricular Septal Rupture
-
An abn communication btwn the right & left ventricle
> blood from left vent pumping out & back into right vent - Rare complication of ventricular septal wall MI
- Usually a late complication
Mechanical Complications of MI - Ventricular Septal Rupture
prevention
complications/symps
treatment
-
Prevention
> early reperfusion -
Complications/Symptoms
> sudden, severe chest pain
> syncope, no warning
> hypotension
> sudden hemodynamic deterioration
> new holysystolic murmur at the left sternal boarder -
Treatment
> dcr afterload
> IABP
> vasodilators; want L vent to have least amnt of resistance
> surgery
Mechanical Complications of MI - Mitral Papillary Muscle Rupture
-
The valve does not fully close
> one or all mitral valve leaflets can be involved; not synchronus
Mechanical Complications of MI - Mitral Papillary Muscle Rupture
complications/symps
treatment
-
Complications/Symptoms
> heart failure
> cardiogenic shock
> mitral valve regurgitation
> New murmur: high-pitched, holosytolic, blowing murmur at cardiac apex heralds mitral valve regurg resulting from papillary muscle dysfunc -
Treatment
> vasodilators
> IABP
Mechanical Complications of MI - Cardiac Wall Rupture
- Occurs either w/in the first 24hrs or at 3-5 days
- Sudden onset
-
Complications/Symptoms
> cardiac tamponade
> cardiogenic shock
> PEA
> Death: w/in mins, L vent getting blood into pericardial sac
Mechanical Complications of MI - Pericarditis
- Inflammation of the pericardial sac
- Occurs during or after acute MI
Mechanical Complications of MI - Pericarditis
complications/symps
treatment
-
Complications/Symptoms
> most common: chest pain
> pericardial friction ruub; auscultate at sternal border, grating, scraping, or leathery scratching
> pericardial effusion
> on a 12-lead ECG, show as global ST elevation -
Treatment
> non steroidal antiinflamm drugs, aspirin, rest
Mechanical Complications of MI - Acute Heart Failure
-
Initial signs & symptoms
> dcrd exercise tolerance
> fluid overload - most reliable clinical sign: jugular venous distention (JVD)
Complication of MI - Nursing Management
Balance myocardial oxygen supply & demand
-
If pt have dcrd cardiac output
> incr cardiac contractility
> positive inotropic meds: dobutamine, dopamine (can be given together)
> phosphodiestrase inhibitor: milrinone -
Coronary artery vasodilators
> nitroglycerine -
Early B blockers
> in absence of cardiogenic shock - Limit activity
Complication of MI - Nursing Management
prevent complications
- Cardiac monitoring
- Assess for s/s continued ischemic pain
-
Diet
> low fat, low sodium - DVT suppression
-
Avoid incring intraabdominal pressure
> valsalva maneuver - Risk factor reduction
Summary - Complications from Electrical Dysfunction
- Bradycardia/tachycardia
- Heart blocks
-
Ventricular dysrhythmias
> PACs, PVCs
Summary - Complications from Mechanical Dysfunction (pump)
- Heart failure
- Pulm edema
- Cardiogenic shock
- Pericarditis
-
New murmur
> ventricular septal rupture
> papillary muscle rupture
