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)

2003 Science Press Internet Services

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 & Dresslers ]
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