Complications of Myocardial Infarction

Mnemonic: DARTH VADER

Death

Arrhythmia

* ACS patients need to be placed on cardiac monitor* Frequently degenerate into non-perfusing rhythms

Rupture of Ventricle

* Occur within a few days of myocardial infarction* Rapid decompensation* Bedside ultrasound will show pericardial effusion and tamponade

Tamponade

* Multiple etiologies* Rupture of ventricle (see above)* Pericarditis* Becks Triad* Jugular vein distension* Muffled heart sounds* Hypotension* Diagnosed with bedside ultrasound* Treatment is pericardiocentesis

Heart Failure

* Occurs in approximately 1/3 post-MI patients* Leads to cardiogenic shock* Treatment* Fluid bolus* Vasopressors (esp. norepinephrine)* Inotropes (milrinone, dobutimine)* Left ventricular assist devices* Intra-aortic balloon pumps

Valve Failure/Rupture

* Rapid decompensation (similar to ventricular wall rupture)* PLUS* New heart murmur* Surgical emergency

Aneurysm

* A classic STEMI mimic* Large Q waves with ST segment elevation (IN ASYMPTOMATIC PATIENT)

Dresslers Syndrome/Pericarditis

* Rule out cardiac tamponade* Treatment* NSAIDS/colchicine

Embolism

* Occur in damaged ventricles and in cardiac aneurysms* Require anticoagulation

Recurrence

* Emphasize lifestyle management

Additional Reading

* Approach to STEMI (EM Clerkship)