EXAM #2: COMPLICATIONS OF MI Flashcards
When are arrhythmias most common in the setting of MI?
Acute phase b/c of ischemia
Do PVCs require specific management in the post-MI setting?
No
What is an accelerated idioventricular rhythm?
Ventricular rhythm with a rate of 60-110 caused by ischemia induced automaticity of purkinje fibers
*Most often seen post-cath. and an indication of reperfusion
What kind of VT is associated with ischemia and how does this differ from VT associated with a post-MI scar?
Ischemia= Polymorphic
Scar= Monomorphic
What is the treatment for VT?
1) Immediate cardioversion
2) Amiodarone
Late VT/VF occurring 48 hours post-MI is associated with _____?
Increased risk of sudden cardiac death
What are the two indications for sudden cardiac death prophylaxis post-MI?
1) Late VT/VF
2) EF less than 35%
What causes sinus bradycardia in the acute phase of a MI?
1) Sinus node ischemia
2) High PNS tone
- Associated with inferior wall MI
When an inferior MI causes a heart block, what level of the conduction pathway is being most affected? Is a permanent pacemaker required?
AV node
Typically, a permanent pacemaker is NOT required b/c this is due to high vagal tone that is TRANSIENT
How does an anterior MI leading to heart block differ from inferior?
Anterior is:
1) Below the AV node
2) Requires permanent pacemaker
*Also much more rare
What is the difference between Killip class 2 and 3?
Class 2= mild pulmonary edema
Class 3= fulminant pulmonary edema
What is the difference between acute and chronic phase MI associated HF?
Acute= diastolic and/or systolic dysfunction
Chronic= systolic dysfunction
How is HF managed in the acute phase of a MI?
1) Vasodilator i.e. NTG
2) Judicious morphine
3) BiPap
How is HF managed in the post-acute phase of a MI?
1) Diuretic
2) ACE-inhibitors
3) Aldosterone antagonists
*In contrast to the acute phase, these patients are retaining fluid
What is a cardioembolism? What is this most commonly associated with?
- Anterior wall dysfunction leads to emboli formation
- Embolism is a cause of “cardioembolic stroke”
*Note that these can embolize to other locations as well e.g. bowels, legs…etc.
How are cardioembolisms treated?
Anticoagulation with warfarin
When is percarditis typically seen post-MI?
Early= within the first week
- Focal inflammation of pericardium overlying the involved myocardium
Late= 1-8 weeks
What is the treatment for early pericarditis? What treatments must be AVOIDED?
1) ASA
2) Colchicine as an adjunct
*Avoid NSAIDs and sterodis
What is Dressler’s Syndrome?
- Autoimmune disease
- Autoantibodies against the percardium
- Associated with malaise, arthralgias, pleural/ pericardial effusion
What labs are associated with Dressler’s Syndrome?
High ESR and CRP
What increases the risk of an Acute VSD post-MI?
1) Delayed or absent reperfusion
2) Elderly
3) Female
4) HTN
5) First MI
List the sx. of an Acute VSD s/p MI.
Chest pain
Dyspnea
Hypotension
Biventricular failure
What are the PE findings associated with an Acute VSD?
- New murmur
- Left low sternal border
- Thrill in 1/2 of patients
How is an Acute VSD diagnosed?
1) Echo*
2) Right heart catheterization
*Gold standard
What is an oxygen saturation “step up” on right heart cath. pathogoominic for?
Acute VSD
What is the most common etiology of acute mitral regurgitation?
Papillary muscle dysfunction
In the setting of inferior MI, what papillary muscle is damaged to cause acute mitral regurgitation?
Posteromedial papillary muscle rupture
What are the symptoms of acute mitral regurgitation?
1) HF sx.
2) Hemodynamic collapse
How does acute mitral valve rupture differ from Acute VSD?
VSD= thrill in 1/2
Mitral Valve Regurg.= no thrill
How do the murmurs of VSD and MR differ?
VSD= loud at LSB
MR= faint
*Note that VSD is associated with both acute and inferior MI vs. MR that is associated with inferior
When does free wall rupture most commonly occur post MI?
1-5 days post MI
How does free wall rupture present?
- Sudden hemodynamic collapse
- Cardiac tamponade
- Feeling of impending doom
How is free wall rupture diagnosed?
1) Echo
2) PA cath. with blunted Y-descent (emptying is impaired)
What is the difference between a LV true and pseudoaneurysm?
True= 3x walls bulge out
- No rupture
Pseudo= tear of endocardium, myocardium–epicardium is the only thing holding this together
- Likely to rupture and require immediate surgical repair
