MEDICAL DISCLAIMER

Medical Disclaimer: The cases presented

here are fictional. These are referenced
and created by Ninja Nerd Inc and are
meant for educational purposes only. This
is not meant to diagnose or treat medical
conditions.
 DDX of Post-MI Complications
❏ Retroperitoneal Hematoma
❏ Post-MI pericarditis
❏ Re-Infarction
❏ Mechanical complications
❏ Papillary muscle rupture
❏ VSD
❏ Free wall rupture
❏ Tachycardias
❏ VT/VF
❏ Bradycardias
❏ Heart blocks
Retroperitoneal Hematoma
❏ Causes
❏ S/P femoral catheterization
❏ Presentation
❏ Hypotension→Shock
❏ Palpable groin hematoma w/ pain
❏ Hemoglobin drop
❏ Diagnostics
❏ CT angiogram of abdomen and
Pelvis
❏ Shows active extravasation
❏ Guides management
❏
❏ Treatment
❏ PRBC transfusion
❏ Stay at least 2 units ahead
❏ Consider FFP, Platelets and
Cryoprecipitate if need for
Massive transfusion protocol
❏ Reverse anticoagulation
❏ Protamine sulfate for heparin
❏ IR
❏ Coil embolization v Covered
stent
❏ Vascular
❏ Hail mary treatment if all else
fails
Post-MI pericarditis
❏ Peri Infarction pericarditis v Dressler
syndrome
❏ 1-3 days post MI→PIP
❏ 2 weeks to months post-MI→DS
❏ Presentation
❏ Pleuritic CP→radiates to trapezius
❏ CP improves leaning forward
❏ Fever
❏ Diagnosis
❏ Friction rub
❏ EKG with diffuse STE and PR segment
depression
❏ ECHO with new or worse effusion
❏ Treatment
❏ High dose aspirin (750-1000mg
q6-8hrs) + PPI for gastroprotection
❏ Colchicine for reducing recurrence
❏ Effusion >1cm or enlarging
❏ Hold anticoagulation
❏
 Re-Infarction
❏ Causes: In stent thrombosis
❏ Presentation
❏ Anginal CP
❏ DDX:
❏ Type II MI due to high demand (hypotension,
hemorrhage, anemia)
❏ Pericarditis
❏ PE
❏ Diagnosis:
❏ EKG→new ischemic changes
❏ Troponins may still be elevated→can check
CK-MB
❏ ECHO→new Wall motion abnormality
❏ Treatment
❏ Instent thrombosis→PCI
❏ Type II MI→BB and maybe Nitroglycerine
Papillary Muscle Rupture
❏ Cause: ❏ Diagnosis:
❏ Commonly involves posterior and medial ❏ CXR→Pulm edema (R>L)
papillary muscle ❏ U/S→B-lines (R>L)
❏ Inferior MI and Posterior MI ❏ ECHO→MR jet on color doppler
❏ Treatment:
❏ This causes collapse of posterior medial
❏ Afterload reduction
leaflet of mitral valve leading to
❏ High dose Nitroglycerin reduces regurg
regurgitation flow
❏ Avoid in HOTN or use NE to
❏ Presentation support hemodynamics
❏ Pulm edema ❏ Inotrope
❏ Hypotension ❏ IABP but don’t delay surgery
❏ Mitral regurg murmur ❏ Surgery
❏ MVR
Ventricular septal Defect
❏ Causes:
❏ Large Anterior MI following LAD occlusion
❏ Presentation:
❏ Pulmonary edema→dyspnea
❏ Sudden hemodynamic collapse
❏ Anginal CP
❏ Diagnosis:
❏ New holosystolic murmur
❏ ECHO
❏ RV dilation
❏ Color doppler shows flow across septum
❏ Treatment:
❏ Afterload reduction
❏ High dose Nitroglycerin reduces regurg
❏ Avoid in HOTN or use NE to support
hemodynamics
❏ Inotrope or IABP but don't delay surgery
❏ Pulmonary edema→BIPAP
❏ Try to not intubate→high risk of hypotension and arrest
❏ Surgery or transcatheter closure of VSD
Ventricular Free wall Rupture
❏ Causes:
❏ Large anterior MI 2/2 LAD occlusion and LCX
❏ Late reperfusion is a risk factor
❏ Presentation
❏ Sudden rupture:
❏ Cardiac tamponade
❏ Cardiac arrest→PEA
❏ Diagnostics:
❏ EKG→may see various findings
❏ ECHO better study in this scenario
❏ Effusion
❏ Contrast ECHO will show extravasation
into pericardium
❏ Throw doppler flow and look for flow into
pericardium
❏ Treatment
❏ Pericardiocentesis
❏ IVF and inotropes
❏ Surgical repair STAT
 VT/VF
❏ Sustained VT→ >30 seconds or HD collapse
❏ Diagnosis:
❏ EKG→Wide Complex Tachycardia
❏ Treatment:
❏ Unstable→DCCV
❏ After DCCV→start amiodarone or lidocaine infusion
❏ To prevent recurrence
❏ Avoid Beta agonists
❏ Check K+ and Mg levels
❏ BB’s if BP can tolerate it
❏ Treat pain and anxiety
❏ Reperfusion→PCI
❏ If PMVT with Prolonged QT-I (TdP)-->stop offending meds and Give
magnesium
❏ If PMVT with normal QT→Reperfusion→PCI
❏ Long term treatment→VT> 48 hours after MI or after
revascularization→ AICD
 Heart Blocks
❏ Causes: ❏ Anterior MI
❏ Inferior MI→AVB ❏ EKG:
❏ Anterior MI→BBB’s ❏ LBBB
❏ Inferior MI ❏ RBBB plus either:
❏ EKG shows JER (narrow QRS with ❏ LAFB
HR: 40-60 bpm) ❏ LPFB
❏ Treatment: ❏ Treatment:
❏ Atropine may help ❏ Transvenous pacer
❏ Epinephrine gtt
❏ Isoproterenol gtt
❏ Transcutaneous pacing
❏ Transvenous pacer
Q&A