MI Complications Flashcards
When are arrythmias most likely to occur?
During acute Myocardial ischemia/Infarct
What is a PVC?
Premature Ventricular Contraction
What is Accelerated Idioventricular Rhythm?
Ventricle takes over pacemaker activity of the heart. Caused by enhanced automaticity of the Purkinjie fibers.
What is Ventricular Tachycardia?
Induced by ischemia QTc may or may not be prolonged Usually Polymorphic VT from a scar is usually Monomorphic Needs immediate Cardioversion Tx with Amiodarone or Lidocaine
What is V Fib?
Late VT/VF > 48 hrs after MI asociated with increased risk of sudden cardiac death following discharge Tx: Defibrillation AMiodarone BB, correct Elytes R/O Recurrent ischemia, reinfarct
What is prophylaxis for sudden cardiac death?
Late VT/VF >48 hrs after MI
EF
What is PCI?
Per-Cutaneous intervention
Putting a stent in to open up a clogged artery
What is the Blood Supply to the Sinus node?
55% RCA
35% LCX
10% dual supply
When are you most likely to see Sinus Bradycardia?
Acute MI from blocked vessel to Sinus Node
RCA, LCX or dual
What is An AV block from an Inferior MI?
Block at AV node level From: high PS tone Local Accumulation of K AV node Ischemia Usually Transient
What is An AV block from an Anterior MI?
Rare
Usually Below AV node level
Implies Extensive infarct with BB inv.
Usually permanent- Needs pacemaker
What is Heart Failure?
secondary to Diastolic Dysfunction(or syst/diast)
Lungs fill up with fluid because of back-up of fluid
What is the Tx for Heart failure during Acture MI?
Vasodilators esp IV nitro
Diuretic if fluid overloaded
Morphine if angina or anxiety (avoid HypoTN, resp distress, high doses)
BiPap, intubation if resp compromise.
What is the Tx for Heart failure during Post Acute phase?
Diuretic ACE- Inhibitors Aldosterone Antagonists -Spironolactone or epleronone Wait on BB til compensated
What is a Cardioembolism?
Associated with large Anterior Wall MI Risk inc when Reduced EF Apical Wall motion abnormality LV aneurism devt Echo can help Diagnose Tx is anticoagulation with warfarin
What is early Pericarditis?
In transmural infarct From local inflammation of pericardium overlying infarcted myocardium Pleuritic chest pain Friction rub ECG changes can be masked
What is Tx of Early Pericarditis vs Late?
Early: aspirin 650 mg
Colchocine(Anti Inf)
Avoid NSAIDS, steroids(Impair Healing)
Late: Dressler’s Syndrome
AI mechanism
Pericarditis + systemic symptoms
Tx- ASA, Colchocine
What are the mechanical complications of MI?
Free wall rupture
VSD
Papillary Muscle Rupture
What are the risk factors for MI related VSD?
AWMI or IWMI Older Pt Females H/O HTN First MI Delayed or absent Reperfusion
Thrombolytics reduce infarct size but promote Hemmorhagic dissection of myocardium
What is the presentation of MI related VSD?
Chest Pain, Dyspnia, Hypotension, Biventriculr Failure
Harsh, Holosystolic Murmur LLSB
Thrill in 50% of Pts
S3, Loud P2
What is an oxygen “Step up?” How does it help you diagnose MI related VSD?
Oxygenated blood from LV comes over to RV and Oxygen readings increase from 66% to 86%. >5% increase is indicative
What is MI related Acute Mitral Regurgitation?
Papillary Muscle Dysfunction
Rumpture of chordae Tendinae
Caused by an inferior MI
Most commonly in the POSTEROMEDIAL PAPILLARY MUSCLE
What is the presentation of MI related Acute Mitral Regurgitation?
Similar to CHF
New systolic murmur (not always loud)
Intensity doesn’t predict severity
“V” Waves
What is the Tx of MI related Acute Mitral Regurgitation?
Mechanical Ventilation
Afterload Reduction by IABP (intra aortic baloon pump)
How can you differentiate VSD from Acute MR?
Thrill present in Half of VSD Pts
Rare in acute MR
What is an MI related Free wall rupture?
Tear or dissecting Hematoma
More common with fibrinolysis compared to PCI
What is the Presentation of MI related Free wall rupture?
Acute: Sudden Hemodynamic Collapse, Cardiac Tamponade, PEA arrest Transient Bradycardia preceding rupture Restless, nauseated, anxious Subacute: Represents a contained rupture Pericardial Pain, Hypotension
How is MI related Free wall rupture diagnosed?
Echo-Pericardial Effusion, Features of tamponade
PA Catheter- Shows tamponade physiology
- Eq of diastolic Pressures
- Blunted y-descent on RA tracing
What is the Tx for Free wall rupture
Emergency Surgical Repair
Pericardiocentesis can be temporary fix
What is Cardiogenic Shock?
Inadequate oxygen and nutrient delivery to the cells
What is an intraortic Baloon pump?
Augments coronary blood flow during diastole
Decreses Afterload
Reduces myocardial Ischemia
