Early and late complications of MI; Mitral stenosis

Question 1

Common Early complications post Myocardial Infarction

Answer 1

• Arrhythmias [VT and VF are the leading causes of intrahospital death | MI allows arrhythmias to develop, both tachy and brady types depending on location of MI, thus new onset arrhythmias are a sign of MI]
• Cardiogenic shock [Contractility failure due to loss of enough tissue can lead to acute HF and cardiogenic shocks, hypoperfusion and end organ damange]
• Recurrent MI [more MI can occur in both early and late phases of MI recovery]
• Strokes [Thrombus growth during MI and arrhythmias can dislodge and cause strokes]

Question 2

Common Late complications of post Myocardial Infarction

Answer 2

Mechanical failures:
- Free wall ruptures
- Intraventricular Septum ruptures
- Ventricular pseudoaneurysms
- Ventricular Aneurysms
- Papillary Muscle ruptures [causing acute MR]

Acute Pericarditis

Dressler Syndrome: Immunological reaction of pericardium about weeks to months after a MI [Fever, malaise, pericarditis, leukocytosis]

Question 3

Mitral Valve stenosis Etiology

Answer 3

• Most common is Rheumatic fever [more common in developing contries]
• Calcification of annulus
• Degenerative Aortic stenosis
• Autoimmune diseases [SLE, Rheumatoid Arthritis]
• Congenital
• Bacterial endocarditis and vegetations

Question 4

Mitral Stenosis Pathophysio

Answer 4

Mitral valve stenosis leads to both a Forward AND Backward Failure [similar to Aortic stenosis]

Question 5

Mitral Stenosis Classification

Answer 5

ACC/AHA classifies Mitral stenosis as follows:
- Stage A: Normal MVA
- Stage B: > 1,5 cmsq MVA | Mild to moderate LA enlargement | Normal PASP
- Stage C: <= 1,5 cmsq MVA | Severe LA enlargement | PASP > 50mmHg | Asymptomatic
- Stage D: Symptomatic stenosis | Exertional dyspnea, decreased exercise tolerance

MVA = Mitral Valve Area
PASP = Pulmonary Artery Systolic Pressure

Question 6

Which arrhythmias are more at risk of developing in Mitral stenosis?

Answer 6

Atrial Fibrillation as LA enlargement forces cardiac remodelling, and the Pulmonary vein isthmus is the location where most of A.fib excess electrical activity develops