Cardiology
MI Complications
Cardiology

MI Complications

VF (<24 h), papillary muscle rupture (3–5 d), free wall rupture, LV aneurysm.

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◆Timeline of complications

  • •First 24 hr: ventricular fibrillation (most common cause of pre-hospital MI death)
  • •1–3 days: post-MI pericarditis (treat with aspirin, NOT NSAIDs early)
  • •3–7 days: papillary muscle rupture (inferior MI → posteromedial → acute MR); free wall rupture → tamponade; VSD
  • •Weeks-months: ventricular aneurysm (persistent ST elevation + Q waves + dyskinetic wall)
  • •Weeks-months: Dressler syndrome (autoimmune pericarditis)

◆Acute MR vs VSD murmurs

  • •Apex holosystolic + sudden flash pulmonary edema = papillary muscle rupture → acute MR
  • •Left lower sternal border holosystolic = post-MI VSD
  • •Posteromedial papillary muscle has single supply (PDA from RCA) → inferior MI

◆Post-MI med management

  • •Pulmonary edema + HTN + no improvement on diuretics → add IV vasodilator (nitroprusside)
  • •DAPT for 12+ months
  • •ACEi/ARB prevents remodeling/LV aneurysm
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