Management of Acute Myocardial
Infarction
Sivanandam Vasudevan
Management of Acute Myocardial
Infarction
• Pre Hospital Phase
• ER
• CCU
• Step-down - Telemetry
• Post Hospital Phase
Complications of Acute Myocardial
Infarction
• Arrhythmic Complications
• Mechanical Complications
• Ischemic Complications
• Miscellaneous Complications
[DVT, PE, Pericarditits, TPA complications,
Pneumonia]
Arrhythmic Complications
[Early < 24 hrs & late >24 hrs]
• Ventricular – PVC, V tach/V Fib
• Atrial – PAC, SVT, A Fib
• Bradycardia – Sinus
• AV block – Complete Heart Block
• LAFB, LPHB, LBBB & RBBB
Mechanical Complications of Acute
Myocardial Infarction
• Papillary Muscle Rupture – Acute MR
• Ventricular Septal Defect
• Right Ventricular MI
• Free Wall Rupture
• Cardiogenic shock
• Cardiac Tamponade
Hemodynamic findings in complications causing
cardiogenic shock with acute MI (a)
• Ac Pul
edema
• Shock
• MR
Mechanisms causing MR during an acute MI and their
treatment modalities
Rupture of papillary
muscle, a rare complication
of acute MI (a)
Rupture of papillary
muscle, a rare complication
of acute MI (b)
Transesophageal echocardiogram in the four-chamber
view
Hemodynamic findings in complications causing
cardiogenic shock with acute MI (b)
• Ac Pul
edema
• Shock
• Systolic
murmur
Ventricular Rupture [VSR]
Ventricular septal rupture (a)
Ventricular septal rupture (b)
Hemodynamic findings in complications causing
cardiogenic shock with acute MI (c)
• CHF
• Clear lungs
• Hypotension
• Systolic
murmur
• Inf. MI
ECG V4 R
Hemodynamic findings in complications causing
cardiogenic shock with acute MI (d)
Hemodynamic findings in complications causing
cardiogenic shock with acute MI (e)
• BP < 90
• Tachycardia
• Pul edema
• Confused
• Skin cold
clammy
• Ant. MI
• Mortality 80%
Regional acute MI, infarct expansion, chamber
thrombosis and aneurysm formation (a)
Regional acute MI, infarct expansion, chamber
thrombosis and aneurysm formation (b)
Regional acute MI, infarct expansion, chamber
thrombosis and aneurysm formation (c)
Regional acute MI, infarct expansion, chamber
thrombosis and aneurysm formation (d)
CT of patients with stroke
as a complication of MI (a)
B
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CT of patients with stroke as a complication of MI (d)
CT of patients with stroke as a complication of MI (c)
© 2003 Science Press Internet Services
CT of patients with stroke as a complication of MI (e)
© 2003 Science Press Internet Services
© 2003 Science Press Internet Services
Incidence of cardiogenic shock complicating acute MI
Incidence of cardiogenic shock complicating acute MI
INCIDENCE OF MECHANICAL,
CAUSES &percnt;
OVERALL INCIDENCE OF
CARDIOGENIC SHOCK
(INCIDENCE ON
PRESENTATION), &percnt;
STUDY
LV FREE
WALL
RUPTURE
ACUTE
VSR
ACUTE
MR
Prethrombolytic era
Killip and
Kimball
&lsqb;6&rsqb;
19
-
-
-
Scheidt
&lsqb;4&rsqb;
15
-
-
-
Hands et al.
*
&lsqb;3&rsqb;
7.1
-
-
-
Goldberg et al.
†
&lsqb;5&rsqb;
7.5 (3.2 )
-
0.9
3.9&percnt;
GISSI-1
&lsqb;20&rsqb;
-(2.4)
-
-
-
LATE
¶
&lsqb;21&rsqb;
-
3.4
-
-
TIMI-II
&lsqb;18&rsqb;
5.8 (1.5)
-
-
-
ISIS-3
&lsqb;17&rsqb;
7.0
1.3
-
-
GUSTO
&lsqb;19&rsqb;
6.1 (0.8)
-
0.5
1.7
‡
§
Thrombolytic era
*
Excludes patients with shock on presentation.
†
‡
§
¶
14&percnt; received thrombolytics.
1976-1988: incidence unchanged.
Within 24 hours of presentation.
Includes all known and suspected cases of rupture.
Rupture of the heart complicates acute MI in about 10%
of cases
Ischemic Complications Post
Myocardial Infarction
Chest pain Post MI
• Recurrent angina
• Recurrent MI
• Pericarditis[ Acute & Dressler’s ]
• Pneumonia
• Pulmonary Embolism
• Shoulder hand syndrome
CT of patients with stroke as a complication of MI (a)
Management of Acute Myocardial Infarction
Pre discharge work up
• Secondary prevention – Diet, Exercise,
Weight control, Smoking cessation
• Lipid control
• B Blockers, ACE Inhibitors, ASA, Statins
• Cardiac Rehabilitation
• Discharge planning
• Pre discharge ECHO, Stress test
Management of Acute Myocardial
Infarction
Thank You