Complications MI

Question 1

Complications of MI

Answer 1

Papillary muscle rupture
VSD / free wall rupture 
Heart failure 
Pericarditis
Cardiac tamponade 
Anaeurysm 
Embolization 
Organ failure 
AF, VT, VF
Mitral regurgitation 
Arrhythmia 
Decreased contractility and CO / cariogenic shock

Question 2

What are acute complications

Answer 2

Cardiogenic shock
Free wall rupture
Septal rupture
Papillary muscle 
VT / AF / AVRNT / AV block

Question 3

What are sub-acute

Answer 3

Post MI Peri-carditis

Dressler

Question 4

What are chronic

Answer 4

LV aneurysm
AF
LV thrombus
Chronic LV dysfunction

Question 5

Mneumonic

Answer 5

DREAD
Death
Rupture septum or papillary
Oedema / new onset HF
Arrhythmia / aneurysm
Dresslers'

Question 6

What arrhythmia are most common

Answer 6

VT / VF
AF
AVRNT
AV block if inferior

Question 7

When does free wall rupture occur

Answer 7

Usually 1-2 weeks post MI

Question 8

How does it present

Answer 8

Acute HF secondary to cardiac tamponade
Tampoande 
- Raised JVP
- Low BP 
- Pulsus paradoxus
- Diminished HS
New murmur - pan systolic

Question 9

Who is more at risk of rupture

Answer 9

Elderly
Female
High BP
Anterior MI - LAD

Question 10

What type of MI causes septal free wall rupture

Answer 10

Anterior MI - LAD area

Question 11

What do you require

Answer 11

CARDIAC ARREST SITUATION
ECHO
Urgent pericardiocentesis
Surgery

Question 12

What is cardiac tamponade

Answer 12

Blood fills around the heart

Question 13

What are the signs of cardiac tamponade

Answer 13

3 D's 
Distended JVP - increased 
Decreased BP 
Distant / muffled HS 
SOB
Renal failure

Question 14

How does papillary muscle rupture present

Answer 14

MITRAL REGURG (harsh systolic) 
Severe SOB from pulmonary oedea
Sweating / N+V from sympa activation 
Chest pain
Shock
Tachycardia
Can have pulmonary oedema and raised JVP

Question 15

How do you Dx

Answer 15

ECHO

Angiogram

Question 16

How do you differentiate papillary and VSD

Answer 16

Cath lab - angio
ECHO

Papillary usually inferior MI
VSD usually septal MI and present more acute

Question 17

How do you treat both ruptures

Answer 17

IV nitrate if systolic >90
Inotrope if <90
IABP to reduce afterload - balloon 
Cardiac surgeon
Repair

Question 18

What are signs of MR

Answer 18

Murmur - harsh systolic
Worsening SOB and increased JVP
Low BP
Will lead to HF

Question 19

How do you Dx and treat

Answer 19

Vasodilator for LVF

Valve replacement

Question 20

What causes pericarditis

Answer 20

Necrotic tissue irritates pericardium

If fluid accumulates = cardiac tamponade which puts pressure on heart and reduces ventricle filling

Question 21

What does pericarditis present like

Answer 21

Central chest pain 
Better forward
Often 1st 24 hours 
ECG changes
ECHO - look for effusion

Question 22

How do you treat pericarditis

Answer 22

NSAID

Colchicine

Question 23

What is dresslers

How do you Dx and RX

Answer 23

Autoimmune pericarditis - 1-3 week post MI
Recurretn effusion
Fever
Pericardial rub
Anaemia
Dx = ECG shows global ST elevation and T inversion, ECHO + raised inflammatory
Rx = NSAID / steroid

Question 24

What else can you get 1-3 week post MI

Answer 24

Late malignant ventricular arrhythmia

Avoid hypokalaemia

Question 25

Ventricular anuerysm When Complications Rx

Answer 25

``` 1 month post Persistent elevation LVF Angina VT Emboli due to thrombus formation Anti-coagulate Surgical ```

Question 26

PE

Answer 26

Due to mural thrombus | Consider anti-coagulation for 3 months post MI

Question 27

What is cardiogenic shock

Answer 27

Inadeqaute tissue perfusion to meet demands

Question 28

What causes cariogenic shock

Answer 28

``` Post MI Arrhythmia PE Tension pneumothorax Cardiac tamponade Myocarditis Endocarditis Dissection ```

Question 29

How do you Dx cardiogenic shock

Answer 29

ECG U+E, troponin, ABG CXR ECHO

Question 30

How do you Rx shock

Answer 30

``` Treat MI / reversible cause CCU Oxygen Diamorphine - pain + anxiety Plasma expander if hypo-perfused Inotropes if overfilled - dobutamine ```

Question 31

How do you measure CO / monitor

Answer 31

``` BP + pulse MAP CVP ABG ECG - every hour until Dx made Urine output ```

Question 32

What is sudden cardiac death

Answer 32

Death due to cardiac cause <6 hours from symptom onset

Question 33

What causes sudden cardiac death

Answer 33

``` STEMI CAD CABG Embolism HCM Long QT Valvular disease ```

Question 34

What is the prognosis

Answer 34

Only 2% survive | Most survivors in VT or VF and can be shocked

Question 35

What are reversible causes of cardiac arrest

Answer 35

``` Hypoxia Hypovolaemia Hyperkalaemia Hypoglycaemia Hypocalcaemia ``` Thrombosis Tension pneumothorax Tamponade Toxin

Question 36

What rhythm will they be in

Answer 36

VT / VF Asystole Pulseless electrical activity

Question 37

How do you treat What do you do if witnessed on cardiac What do you do if not witnessed

Answer 37

CPR Defib Adrenaline if VF / VT after 3rd shock and every 5 minutes if witnessed on cardiac monitor 1 shock + adrenaline if not witnessed on cardiac monitor Amiadarone

Question 38

If patient go into cariogenic shock after MI what do you do

Answer 38

ABCDE Require bedside ECHO to look for any complication Inotrope / vasopressor Surgery