“Post-MI Complications” Links And Excerpts From The Chapter In The Internet Book Of Critical Care By Dr. Josh Farkas

In this post, I link to and excerpt from the Post-MI Complications chapter of the Intenet Book Of Critical Care by Dr. Josh Farkas, Nov. 24, 2021.

All that follows is from the above resource.


approach to deteriorating post-MI patient

differential diagnosis for deterioration s/p MI
  • Reinfarction (e.g., in-stent thrombosis).📖
  • Rupture:
    • Ventricular free wall rupture.📖
    • Ventricular septal defect (VSD).📖
    • Mitral valve chordae tendinae rupture.📖
  • Post-MI Pericarditis (Post-cardiac injury syndrome).📖
  • Hemorrhage (e.g., retroperitoneal hemorrhage 📖).
  • Medication effect (e.g., beta-blockers, ACE-inhibitors, diuretics).
  • Arrhythmia.
    • Atrial fibrillation/flutter.📖
    • Ventricular tachycardia (VT).📖
    • Heart block.📖
  • Other complications:
    • Pneumothorax.
    • Aortic dissection.
    • Pulmonary embolism.
    • Infection (e.g., ventilator-associated pneumonia, line infection).
investigation of delayed deterioration
  • Review any recent interventions (e.g., medications, procedures).
  • EKG (new ischemia?).
  • Auscultation:
    • ? New murmur (mitral regurgitation, VSD).
    • ? Pericardial friction rub.
  • Echocardiogram:
    • ? Pericardial effusion (pericarditis, ventricular wall rupture).
    • ? New mitral regurgitation.
    • ? New aortic regurgitation (may suggest aortic dissection).
    • ? Fall in ejection fraction or new wall motion abnormality (reinfarction, excess beta-blockers).
    • ? Evidence of VSD (color doppler shows flow across septum).
    • ? Hypovolemia (hemorrhage, over-diuresis).
    • ? RV dilation (RV infarction, PE, VSD).


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