Post MI Complications - Dr. Nichols

Mechanical Issues

Acute mitral regurg 
     - 7 to 10 days post MI
     - can result from papillary muscle rupture
     - often complication of inferior MI
     - can cause abrupt cardiogenic shock

     - best tx = afterload reduction with diuretics, nitroprusside, Surgery.

Ventricular septal rupture
     - first 24 hrs and at 2-5 days
     - findings: holosystolic murmur, CP, painless hypotension

     - tx: O2, surgery, vasodilators, nitroprusside

Ventricular aneurysm
     - findings: CHF +/- shock
     - dx: CXR w/ enlarged silhouette
     - At risk for thromboembolism.

Ventricular free wall rupture
     - cause hemopericardium/tamponade
     - signs: CP, hypotension, tamponade


Post MI Arrhythmias

• Prophylactic Antiarrhythmics?  Lidocaine and 1C antiarrhythmics increase mortality
  
• Atrial arrhythmias need to be respected!!  Can be sign of impending failure!

Dressler's Syndrome

• signs: fever, malaise, pleuritic CP, tachycardia, pericardial friction rub
• dx: ST elevation, PR depression
• tx: NSAIDs

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