MI Complications

Question 1

What is the most common cause of death following MI?

Answer 1

Ventricular fibrillation

Question 2

What can ventricular fibrillation lead to?

Answer 2

Cardaic arrest

Question 3

How are patients with cardiac arrest post MI managed?

Answer 3

ALS protocol with defibrillation

Question 4

How can cardiogenic shock result post MI?

Answer 4

Large part of the ventricular myocardium is damaged in the infarction- ejection fraction decreases to the point of cardiogenic shock

Question 5

What is the other possible cause of caridogenic shock post MI?

Answer 5

Left ventricular free wall rupture

Question 6

When does left ventricular free wall rupture occur post MI?

Answer 6

1-2 weeks afterward

Question 7

How does a patient with left ventricular free wall rupture present?

Answer 7

Acute heart failure secondary to cardiac tamponade

Question 8

What are the symptoms of acute heart failure secondary to cardiac tamponade?

Answer 8

Raised JVP
Pulsus paradoxus
Diminished heart sounds

Question 9

What is the management of left ventricular free wall rupture?

Answer 9

Urgent pericardiocentesis and thoracotomy

Question 10

How can a patient end up with post MI chronic heart failure?

Answer 10

Ventricular myocardium may be dysfunctional

Question 11

What medication can be used in the management of post MI chronic heart failure?

Answer 11

Furosemide- decrease fluid overload
ACE-inhibitors and beta-blockers- improve the long-term prognosis

Question 12

When can pericarditis present post MI?

Answer 12

Within 48 hours following a transmural MI

Question 13

What are the main features of a post MI pericarditis?

Answer 13

Pain- worse on lying flat
Pericardial rub on ausculttaion
Pericardial effusion on echocardiogram.

Question 14

When does Dressler’s syndrome typically occur?

Answer 14

2-6 weeks following a MI.

Question 15

What is Dressler’s syndrome due to?

Answer 15

Autoimmune reaction against antigenic proteins formed as the myocardium recovers

Question 16

What are the characteristic features of Dressler’s syndrome?

Answer 16

Fever
Pleuritic pain
Pericardial effusion
Raised ESR

Question 17

How is Dressler’s syndrome managed?

Answer 17

NSAID’s

Question 18

How can the ventricular septum be affected by a MI?

Answer 18

The interventricular septum can be ruptured

Question 19

When can the rupture of the interventicular septum occur?

Answer 19

In the first week

Question 20

How can a ruptured interventricular septum present?

Answer 20

Acute heart failure associated with a pan-systolic murmur

Question 21

What is diagnostic investigation for a ruptured interventricular septum?

Answer 21

Echocardiogram

Question 22

What is the advantage of using an echocardiogram for someone with a ruptures interventricular septum?

Answer 22

Can differentiate from mitral regurgitation which can present in a similar way

Question 23

What is the management of a ruptured interventricular septum?

Answer 23

Urgent surgical correction

Question 24

What type of MI is acute mitral regurgitation a more common complication of?

Answer 24

Infero-posterior infarction

Question 25

What can acute mitral regurgitation be due to?

Answer 25

Ischaemia or rupture of the papillary muscle.

Question 26

How can acute mitral reguritation present?

Answer 26

Acute hypotension
Pulmonary oedema
Early-to-mid systolic murmur

Question 27

How is acute mitral regurgitation managed?

Answer 27

Vasodilator therapy
Often requires emergency surgical repair.

Question 28

How can a left ventricular anneurysm occur post MI?

Answer 28

The ischaemic damage sustained may weaken the myocardium resulting in aneurysm

Question 29

What is a left ventricular anneurysm associated with?

Answer 29

Persistent ST elevation and left ventricular failure.

Question 30

What can form within the left ventricular anneurysm?

Answer 30

Thrombus- increases risk of stroke