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Infarction
Sivanandam Vasudevan
Management of Acute Myocardial
Infarction
• Arrhythmic Complications
• Mechanical Complications
• Ischemic Complications
• Miscellaneous Complications
[DVT, PE, Pericarditits, TPA complications,
Pneumonia]
Arrhythmic Complications
[Early < 24 hrs & late >24 hrs]
• Ac Pul
edema
• Shock
• MR
Mechanisms causing MR during an acute MI and their
treatment modalities
Rupture of papillary Rupture of papillary
muscle, a rare complication muscle, a rare complication
of acute MI (a) of acute MI (b)
Transesophageal echocardiogram in the four-chamber
view
Hemodynamic findings in complications causing
cardiogenic shock with acute MI (b)
• Ac Pul
edema
• Shock
• Systolic
murmur
Ventricular Rupture [VSR]
• CHF
• Clear lungs
• Hypotension
• Systolic
murmur
• Inf. MI
ECG V4 R
Hemodynamic findings in complications causing
cardiogenic shock with acute MI (d)
Hemodynamic findings in complications causing
cardiogenic shock with acute MI (e)
• BP < 90
• Tachycardia
• Pul edema
• Confused
• Skin cold
clammy
• Ant. MI
• Mortality 80%
Regional acute MI, infarct expansion, chamber
thrombosis and aneurysm formation (a)
Regional acute MI, infarct expansion, chamber
thrombosis and aneurysm formation (b)
Regional acute MI, infarct expansion, chamber
thrombosis and aneurysm formation (c)
Regional acute MI, infarct expansion, chamber
thrombosis and aneurysm formation (d)
CT of patients with stroke CT of patients with stroke as a complication of MI (c)
as a complication of MI (a) B
OVERALL INCIDENCE OF
LV FREE
CARDIOGENIC SHOCK ACUTE ACUTE
STUDY WALL
(INCIDENCE ON VSR MR
RUPTURE
PRESENTATION), %
Prethrombolytic era
Killip and
Kimball 19 - - -
[6]
Scheidt
15 - - -
[4]
Hands et al.
* 7.1 - - -
[3]
Goldberg et al. ‡ §
† 7.5 (3.2 ) - 0.9 3.9%
[5]
Thrombolytic era
GISSI-1
-(2.4) - - -
[20]
LATE
¶ - 3.4 - -
[21]
TIMI-II
5.8 (1.5) - - -
[18]
ISIS-3
7.0 1.3 - -
[17]
GUSTO
6.1 (0.8) - 0.5 1.7
[19]
*
Excludes patients with shock on presentation.
†
14% received thrombolytics.
‡
1976-1988: incidence unchanged.
§
Within 24 hours of presentation.
¶
Includes all known and suspected cases of rupture.
Rupture of the heart complicates acute MI in about 10%
of cases
Ischemic Complications Post
Myocardial Infarction
Chest pain Post MI
• Recurrent angina
• Recurrent MI
• Pericarditis[ Acute & Dressler’s ]
• Pneumonia
• Pulmonary Embolism
• Shoulder hand syndrome
CT of patients with stroke as a complication of MI (a)
Thank You