Complications of Myocardial Infarction

Mnemonic: DARTH VADER Death Arrhythmia * ACS patients need to be placed on cardiac monitor* Frequently degenerate into non-perfusing rhythms Rupture of Ventricle * Occur within a few days of myocardial infarction* Rapid decompensation* Bedside ultrasound will show pericardial effusion and tamponade Tamponade * Multiple etiologies* Rupture of ventricle (see above)* Pericarditis* Becks Triad* Jugular vein distension* Muffled heart sounds* Hypotension* Diagnosed with bedside ultrasound* Treatment is pericardiocentesis Heart Failure * Occurs in approximately 1/3 post-MI patients* Leads to cardiogenic shock* Treatment* Fluid bolus* Vasopressors (esp. norepinephrine)* Inotropes (milrinone, dobutimine)* Left ventricular assist devices* Intra-aortic balloon pumps Valve Failure/Rupture * Rapid decompensation (similar to ventricular wall rupture)* PLUS* New heart murmur* Surgical emergency Aneurysm * A classic STEMI mimic* Large Q waves with ST segment elevation (IN ASYMPTOMATIC PATIENT) Dresslers Syndrome/Pericarditis * Rule out cardiac tamponade* Treatment* NSAIDS/colchicine Embolism * Occur in damaged ventricles and in cardiac aneurysms* Require anticoagulation Recurrence * Emphasize lifestyle management Additional Reading * Approach to STEMI (EM Clerkship)