“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.

CONTENTS

• Approach to the deteriorating post-MI patient
• Retroperitoneal hematoma
• Post-MI pericarditis
• Re-infarction
• Mechanical complications
  • Mitral valve chordae tendinae rupture
  • Ventricular septal defect (VSD)
  • Ventricular free wall rupture
• Tachyarrhythmia
  • Atrial fibrillation or atrial flutter
  • Ventricular tachycardia (VT)
• Bradyarrhythmia
  • Heart block s/p MI
• Podcast
• Questions & discussion
• Pitfalls

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).