Wednesday, May 9, 2012

Complications post MI

Sinus bradycardia : give atropine if symptomatic

3rd degree AV block:  Usually ffing Inf wall MI (ST elevation in leads II, III and avf) - bradycardia, there's independent contraction of RA and RV leading to Canon A waves (in Jugular). Treatment is pacemaker

Right Ventricle infarction: (also Inf Wall MI), RV dysfxn leads to reduced pulmonary bld flow, low preload, hypotension especially with nitrate use, tachycardia. Lungs are clear.Tmt is high volume fluid infusion. Avoid nitroglycerin
(vasodilator).

Ventricular fibrillation/tachycardia: loss of pulse, ECG findings. Tmt: defibrillation if no pulse

Reinfarction: recurrence of pain, new signs of pulmonary edema, new rise in CK-MB (Troponin is useless high cos level remains high for 10-14 days after initial infarction unlike CK-MB- 1-2 days) Tmt: As new MI

Free wall rupture: usually 2-8 days post MI when scars are forming but can occur as early as within the first 24hours, leads to cardiac tamponade, hypotension, JV distension, sudden loss of pulse. Do Echo. Tmt: emergency pericardiocentesis then surgical repair

Septal rupture: septal defect forms, new pansystolic (VSD) murmur hrd best at LLSB, pulmonary congestion, step up in oxygen saturation as you move from right atrium to right ventricle. Do Echo

Valve rupture: valvular insufficiency, mitral regurgitation, new systolic murmur heard best at apex radiating to axilla. Do Echo


edited: mechanical complications (rupture) can occur as early as the first day of MI although more common days and weeks after.

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