0071643192.pdf

CARDIOVASCULAR EMERGENCIES

TABLE 2.9. Complications of Myocardial Infarction

CLINICALFEATURES TREATMENT

Early Complications

Congestive heart Ranging from mild congestion Standard MI therapy

failure (Killip II MI) to pulmonary edema Diuresis

(Killip III MI) (15–40% mortality) Reperfusion

Cardiogenic shock Pulmonary congestion and Reperfusion

peripheral hypoperfusion Inotropes

(Killip IV MI; 80% mortality) Balloon pump

Bradydysrhythmias Inferior MI: Observation

and AV block AV nodal, proximal to HIS bundle Transvenous pacing if:

Stable and transient Symptomatic bradycardia, 2nd-

Anterior MI: degree AVB type II, new

Infranodal at lower HIS bundle, bifascicular block with Ist-degree

poor prognosis AV block, bilateral BBB

Respond poorly to therapy

Tachydysrhythmias Occur in majority of patients ACLS

Left ventricular free Rapid decline to PEA, pericardial Pericardiocentesis and surgical

wall rupture effusion on ultrasound repair

Rupture of inter- Rapid decline with new, Surgical repair

ventricular septum harsh, systolic murmur

Papillary muscle Day 3—5 after inferior MI. Surgical repair

rupture Acute pulmonary edema

with new systolic murmur.

Infarct pericarditis Transmural infarct Supportive care

(different from ECG abnormalities often

Dressler’s syndrome) masked by evolutionary changes

Late Complications

LV thrombus Stroke or emboli Anticoagulation

Pleuropericarditis 2—10 weeks post-MI NSAIDs and steroids

(Dressler’s syndrome) Fever, leukocytosis, friction rub,

pericardial or pleural effusion

LV aneurysm Following large MI Anticoagulation,

(anterior most common) surgery

CHF, dysrhythmias,

thromboemboli, persistent

ST-elevation on ECG