complications of an M.I.

Question 1

Mechanical complications

Answer 1

• Free wall rupture
• Septal Rupture
• Papillary muscle rupture

Question 2

Free wall rupture

Answer 2

• Most common complication in week POST MI
• Usually leads to death unless contained within a False aneurysm
• ECHO, periocardiocentesis and drainage should be performed as soon as possible
• If patient survives they are usually sent to have immediate surgery

Question 3

Risk factors for free wall rupture

Answer 3

• Female
• Anterior MI
• Elderly
• High BP

Question 4

What can free wall rupture lead to?

Answer 4

• cardiac tamponade

- haemopericardium : blood in the pericardial sac

Question 5

Septal wall rupture

Answer 5

• very uncommon
• presents in patients who present with multiple- vessel CAD
• more common in females, elderly, HBP
• most common in anterior and inferior MIs

Question 6

Papillary muscle rupture

Answer 6

• Most common in first week after MI
• Occurs in small infarcts
• Very small chance of survival

Question 7

Signs of papillary muscle rupture

Answer 7

• Increased JVP
• Right parasternal Heave
• severe SOB
• HARSH systolic murmur
• tachycardia
• pulmonary oedema
• chest pain

Question 8

Investigations and findings in Pap Muscle rupture

Answer 8

ECHO 
Catherisation
Findings:
-mitral valve prolapse 
-mitral regurgitation

Question 9

Treatment to Pap muscle rupture

Answer 9

Medical treatment is only temporary:

• IV nitrates if SBP >90mmHg
• Inotropes if SBP <90 mmHg
• Intra aortic balloon pump- reduces after load

Surgery:

• MV replacement rather than repair
• CABG

Question 10

Arrythmias

Answer 10

-ventricular tachycardia
can occur at any point- due to ischaemia
can be treated with cardioversion/ AMIODARONE
-Ventricular fibrillation
must be treated with a defibrillator
can quickly lead to systole

Question 11

LV thrombus

Answer 11

Seen in apical MIs

After 48 hours treated with warfarin for 6/12 post episode