Complications of Myocardial Infarction

Mnemonic: DARTH VADER

Death

Arrhythmia

  • ACS patients need to be placed on cardiac monitor
  • Frequently degenerate into non-perfusing rhythms

Rupture of Ventricle

  • Occur within a few days of myocardial infarction
  • Rapid decompensation
  • Bedside ultrasound will show pericardial effusion and tamponade

Tamponade

  • Multiple etiologies
    • Rupture of ventricle (see above)
    • Pericarditis
  • Becks Triad
    • Jugular vein distension
    • Muffled heart sounds
    • Hypotension
  • Diagnosed with bedside ultrasound
  • Treatment is pericardiocentesis

Heart Failure

  • Occurs in approximately 1/3 post-MI patients
  • Leads to cardiogenic shock
  • Treatment
    • Fluid bolus
    • Vasopressors (esp. norepinephrine)
    • Inotropes (milrinone, dobutimine)
    • Left ventricular assist devices
    • Intra-aortic balloon pumps

Valve Failure/Rupture

  • Rapid decompensation (similar to ventricular wall rupture)
  • PLUS
  • New heart murmur
  • Surgical emergency

Aneurysm

  • A classic STEMI mimic
  • Large Q waves with ST segment elevation (IN ASYMPTOMATIC PATIENT)

Dresslers Syndrome/Pericarditis

  • Rule out cardiac tamponade
  • Treatment
    • NSAIDS/colchicine

Embolism

  • Occur in damaged ventricles and in cardiac aneurysms
  • Require anticoagulation

Recurrence

  • Emphasize lifestyle management

Additional Reading

1 Comment

  1. Zack

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