MI complications + secondary prevention Flashcards
(16 cards)
key MI complications
cardiac arrest
cardiogenic shock
chronic heart failure
tachy/bradyarrhythmias
pericarditis
left ventricular aneurysm
left ventricular free wall rupture
ventricular septal defect
acute mitral regurg
most common cause of death post-MI
cardiac arrest
- due to patients developing ventricular FIBRILLATION
cardiogenic shock post MI
if large part of ventricular myocardium is damaged, the ejection fraction of the heart may decrease to the point the patient develops cardiogenic shock
- difficult to treat
- other causes include mechanical cx - LV free wall rupture
chronic heart failure post MI
damage means ventricular myocardium may be dysfunctional resulting in chronic HF
- furosemide - decrease fluid overload
- ACEi+beta-block - shown to improve long term prognosis
which type of MIs are most likely to precede atrioventricular block as a complication
inferior MIs !!
pericarditis post MI
common in first 48hrs following transmural MI
- pericardial effusion may be demonstrated on echo
2-6wks after MI = Dressler’s syndrome
Dresslers syndrome
pericarditis 2-4wks post MI
- autoimmune reaction against antigenic proteins formed as myocardium recovers
px = fever, pleuritis chest pain, pericardial effusion, raised ESR
management of Dressler’s syndrome
NSAIDs
left ventricular aneurysm post MI
damage weakens myocardium resulting in aneurysm formation
typically assoc with
- persistent ST elevation + LV failure
!! sx same as heart failure !!
thrombus may form - risk of stroke -> anticoagulate
Left ventricular free wall rupture post MI
1-2weeks after MI
px = acute heart failure secondary to cardiac tamponade
- raised JVP
- pulsus paradoxus
- diminished heart sound
mx = urgent pericardiocentesis + thoracotomy
ventricular septal defect (rupture of interventricular septum) post MI
occurs in first week, seen in 1-2%
px = acute heart failure assoc with a pan-systolic murmur
diagnosis = echo, will exclude mitral regurg (presents similar)
mx = surgery urgent
which type of MI is most likely to cause acute mitral regurg
infero-posterior infarction, may be due to ischaemia or rupture of papillary muscle
2-7days after MI
acute hypotension + pulmonary oedema may occur
- early-mid systolic murmur
mx = vasodilator, surgical repair
secondary prevention of MI drugs
dual antiplatelet - aspirin + another antiplatelet
ACEi
beta blocker
statin
when are aldosterone antagonists used post MI
patients who have had an acute MI + who have sx or signs of heartfailure + left ventricular systolic dysfunction
- should be initiated 3-14days of MI
- preferably AFTER ACEi
eplerenone
DAPT post ACS vs post PCI
post ACS - ticagrelor + aspirin, stop ticagrelor at 12 months
post PCI = add prasugrel/ticagrelor to aspirin, stop after 12 months
(12months altered for those at high risk)
lifestyle points post MI
- advise mediterranean diet, butter + cheese for plant based oils
- do not recommend omega 3 supp
- 20-30 mins of exercise until “slightly breathless”
- sex may resume 4wks after uncomplicated MI
– sex does not increased likelihood of further MI
