Mind Map Gallery Early And Late Complications of Myocardial Infarction Mind Map
Mind map of early and late complications of myocardial infarction: Early complications include ventricular fibrillation, conduction deficits, arrhythmias, shock, and reperfusion injury. Late complications are divided into two categories: mechanical and non-mechanical/metabolic. Mechanical complications include ventricular aneurysm, papillary muscle rupture, ventriculi septal defect, left ventricular pseudoaneurysm, and right ventricular aneurysm. Non-mechanical or metabolic late complications include heart failure, cardiogenic shock, or arrhythmia, for example, atrial fibrillation or bradycardia. Use EdrawMind to create similar mind maps for your personal and professional requirements.Edited at 2022-11-25 16:58:04
Topic 8A. Early and late complications of the myocardial infarction
1. Postinfarction ischemia -Recurrent ischemia occurs in about 1/3 of patients. Its more common in NSTEMI than STEMI. It has important short-and long-term prognostic factors. Vigorious medical therapy should be instituted, including nitrates and beta blockers, aspirin, anticoagulation therapy and clopidogrel. All patients with postinfarction angina should undergo early catheterization and revascularization.
2.Arrhythmias abnormalities of rhythm and conduction are common.
a. Sinus bradycardia most common after inferior infarctions or may be precipitated by medications. Usually stop administering the affective agent and the symptoms disappear. If accompanied by signs of low CO, atropine 0,5-1mg IV is usually affective.
B.supra-ventricular tachyarrhythmia 1.Sinus tachycardia 2.Supraventricular premature beats 3.Atrial fibrillation 4.IV beta blockers are the agents of choice if cardiac function is adequate 5.IV diltiazem may be used if BB are contraindicated 6.Digoxin 0,5mg as initial dose and then 0,25mg as a loading dose is used if heart failure is present with atrial fibrillation. 7.Electrical cardioversion is necessary if atrial fibrillation is complicated by hypotension, heart failure or ischemia. The arrhythmia often recurs. Amiodarone may be helpful of restoring sinus rhythm (pharmaceutical cardioversion).
C.Ventricular arrhythmias -Most common in the first few hours of infarction and are a marker of high risk. -Ventricular premature beats may lead to ventricular tachycardia or fibrillation -Ventricular tachycardia which is sustained should be treated either with lidocaine or procainamide or IV amiodarone -Ventricular fibrillation is treated electrically. -Accelerated idioventricular rhythm is regular wide-complex rhythm at 70-100 bpm. -It may recur with or without reperfusion and should not be treated with antiarrhythmics, which could cause asystole.
D.Conduction disturbances a. All degrees of AV block can occur after acute MI. i.First degree AV block is the most common and requires no treatment ii.Second degree AV block (Mobitz 1) only requires treatment if symptoms are present iii.Complete AV block occurs in upto 5% of acute inferior MIs. They generally resolve spontaneously. Though they may persist for hours or weeks. -Treatment is often necessary due to hypotension an dlow CO. -IV atropine and temporary ventricular pacing
3.Myocardial dysfunction person with hypotension not responsive to fluid resuscitation or refractory heart failure or cardiogenic shock should be considered for urgent echo to assess left and right ventricular function and for mechanical complications, right heart catheterization an continuous measurements of atrial pressure.
. Acute LV failure
•Dyspnea, diffuse rales and arterial hypoxemia usually indicate LV failure. •Give O2 and get the saturation above 95% •Elevate the trunk of patient •Give diuretics (initial therapy) if RV infarct is not present o Hypotension can result •Morphine sulfate is valuable in acute pulmonary edema •If BP is high enough, Nitrates can be given (but they are powerful vasodilators so the MAP has to be > 100mmHg and MAP should be monitored when administering them). •Doputamine has good effect, it increases CO usually without excessive tachycardia, hypotension or arrhythmias •Digoxin may only be helpful in this case if heart failure persists.
Hypotension and shock
•Patients with hypotension (systolic BP < 90 mmHg) and signs of diminished perfusion (low urinary output, confusion, cold extremities) that does not respond to fluid resuscitation should be presumed to have cardiogenic shock and should be considered for urgent catheterization and revascularization. •Many patients will have IV hypovolemia due to diaphoresis (sweating), vomiting, decreased venous tone due to medications). Most patients will have moderate LV function (EF around 30%) •Pericardial tamponade due to hemorrhagic pericarditis should be considered and diagnosed with echo. •Dopamine is considered the best treatment for cardiogenic hypotension -At low doses it improves renal blood flow, at intermediate doses it improves myocardial contractility and at high doses it is a potent alpha 1 agonist -->Thus, in general, BP and CO increase. With dopamine vasopressors are usually also given (norepi is not given unless other vasopressors fail (doputamine, nitroprussine etc.) •Patients with cardiogenic shock not due to hypovolemia have poor prognosis, 30 day mortality rate is 40-80%.
6. Myocardial rupture Complete rupture of LV free wall occurs in under 1% of patients and usually results in immediate death. It usually occurs 2-7 days postinfarction, usually involves the anterior wall and usually occurs in older women. Incomplete or gradual rupture may be sealed off by the pericardium, creating a pseudoaneurysm. Early surgical repair is indicated.
5. Mechanical defects •partial or complete rupture of papillary muscle •rupture of interventricular septum •Occurs in under 1 % of MI patients, this has poor prognosis and identified by new murmurs appearing after MI, often with pulmonary edema. We can diagnose this by echo. Surgical correction is usually necessary.
4.RV infarction Its present in 1/3 of patients with inferior wall infarction but often not clinically significant. It presents as hypotension with preserved LV function. Hypotension can be exacerbated by medication. The diagnosis can be confirmed by echo or hemodynamic measurements. Therapy is fluid loading.
7. LV aneurysm An LV aneurysm, a sharply delineated are of scar that bulges paradoxically during systole, develops in 10-20% of post MI patients. This usually follows anterior Q wave infarctions. There is persistent ST elevation. They rarely rupture, however may be associated with arterial emboli, ventricular arrhythmias, and heart failure.
8. Pericarditis -The pericardium is involved in 50% of infarctions, but pericarditis is often not clinically significant. -Some patients have audible friction rub. -Often no treatment is necessary, but aspirin will usually relieve pain.
9.Mural thrombus Mutal thrombi are common in anterior infarctions but not in infarctions of other locations. Arterial emboli occur in approximately 2% of patients with known infarction, ususally within 6 weeks. Anticoagulation with heparin followed by short Warfarin therapy (3 months) prevents most emboli and should be considered in all patients with anterior infarctions.