EXAM #2: COMPLICATIONS OF MI

Question 1

When are arrhythmias most common in the setting of MI?

Answer 1

Acute phase b/c of ischemia

Question 2

Do PVCs require specific management in the post-MI setting?

Answer 2

No

Question 3

What is an accelerated idioventricular rhythm?

Answer 3

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

Question 4

What kind of VT is associated with ischemia and how does this differ from VT associated with a post-MI scar?

Answer 4

Ischemia= Polymorphic

Scar= Monomorphic

Question 5

What is the treatment for VT?

Answer 5

1) Immediate cardioversion

2) Amiodarone

Question 6

Late VT/VF occurring 48 hours post-MI is associated with _____?

Answer 6

Increased risk of sudden cardiac death

Question 7

What are the two indications for sudden cardiac death prophylaxis post-MI?

Answer 7

1) Late VT/VF

2) EF less than 35%

Question 8

What causes sinus bradycardia in the acute phase of a MI?

Answer 8

1) Sinus node ischemia
2) High PNS tone
- Associated with inferior wall MI

Question 9

When an inferior MI causes a heart block, what level of the conduction pathway is being most affected? Is a permanent pacemaker required?

Answer 9

AV node

Typically, a permanent pacemaker is NOT required b/c this is due to high vagal tone that is TRANSIENT

Question 10

How does an anterior MI leading to heart block differ from inferior?

Answer 10

Anterior is:

1) Below the AV node
2) Requires permanent pacemaker

*Also much more rare

Question 11

What is the difference between Killip class 2 and 3?

Answer 11

Class 2= mild pulmonary edema

Class 3= fulminant pulmonary edema

Question 12

What is the difference between acute and chronic phase MI associated HF?

Answer 12

Acute= diastolic and/or systolic dysfunction

Chronic= systolic dysfunction

Question 13

How is HF managed in the acute phase of a MI?

Answer 13

1) Vasodilator i.e. NTG
2) Judicious morphine
3) BiPap

Question 14

How is HF managed in the post-acute phase of a MI?

Answer 14

1) Diuretic
2) ACE-inhibitors
3) Aldosterone antagonists

*In contrast to the acute phase, these patients are retaining fluid

Question 15

What is a cardioembolism? What is this most commonly associated with?

Answer 15

• 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.

Question 16

How are cardioembolisms treated?

Answer 16

Anticoagulation with warfarin

Question 17

When is percarditis typically seen post-MI?

Answer 17

Early= within the first week
- Focal inflammation of pericardium overlying the involved myocardium

Late= 1-8 weeks

Question 18

What is the treatment for early pericarditis? What treatments must be AVOIDED?

Answer 18

1) ASA
2) Colchicine as an adjunct

*Avoid NSAIDs and sterodis

Question 19

What is Dressler’s Syndrome?

Answer 19

• Autoimmune disease
• Autoantibodies against the percardium
• Associated with malaise, arthralgias, pleural/ pericardial effusion

Question 20

What labs are associated with Dressler’s Syndrome?

Answer 20

High ESR and CRP

Question 21

What increases the risk of an Acute VSD post-MI?

Answer 21

1) Delayed or absent reperfusion
2) Elderly
3) Female
4) HTN
5) First MI

Question 22

List the sx. of an Acute VSD s/p MI.

Answer 22

Chest pain
Dyspnea
Hypotension
Biventricular failure

Question 23

What are the PE findings associated with an Acute VSD?

Answer 23

• New murmur
• Left low sternal border
• Thrill in 1/2 of patients

Question 24

How is an Acute VSD diagnosed?

Answer 24

1) Echo*
2) Right heart catheterization

*Gold standard

Question 25

What is an oxygen saturation “step up” on right heart cath. pathogoominic for?

Answer 25

Acute VSD

Question 26

What is the most common etiology of acute mitral regurgitation?

Answer 26

Papillary muscle dysfunction

Question 27

In the setting of inferior MI, what papillary muscle is damaged to cause acute mitral regurgitation?

Answer 27

Posteromedial papillary muscle rupture

Question 28

What are the symptoms of acute mitral regurgitation?

Answer 28

1) HF sx.

2) Hemodynamic collapse

Question 29

How does acute mitral valve rupture differ from Acute VSD?

Answer 29

VSD= thrill in 1/2

Mitral Valve Regurg.= no thrill

Question 30

How do the murmurs of VSD and MR differ?

Answer 30

VSD= loud at LSB

MR= faint

*Note that VSD is associated with both acute and inferior MI vs. MR that is associated with inferior

Question 31

When does free wall rupture most commonly occur post MI?

Answer 31

1-5 days post MI

Question 32

How does free wall rupture present?

Answer 32

• Sudden hemodynamic collapse
• Cardiac tamponade
• Feeling of impending doom

Question 33

How is free wall rupture diagnosed?

Answer 33

1) Echo

2) PA cath. with blunted Y-descent (emptying is impaired)

Question 34

What is the difference between a LV true and pseudoaneurysm?

Answer 34

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