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)