Early Complications of post - MI

Clinical complications of myocardial infarction will depend upon the - size and location of the infarction - pre-existing myocardial damage.

Early post - MI Complications

ACT RAPID
Arrhythmias Cardiac Failure Thromboembolic disorder Rupture (Ventricle, septum, papillary muscle) Aneurysm (Ventricle) Pericarditis Infection Death / Dresslers Syndrome

Arrthymias
Arrhythmia is the most common complication after acute MI. It is related to the formation of re-entry circuits at the confluence of the necrotic and viable myocardium. Premature Ventricular Contractions ~ 90% Complete AV Block ~ 20% with Right Ventricular infarct Ventricular fibrillation ~ 2 - 4% Supraventricular ~ 10% Brady arrhythmias common with inferior MI

Cardiac Failure
Cardiac Failure post STEMI is a poor prognostic feature that necessitates medical and invasive therapy to reduce mortality rate. Killip Classification used to assess pt with heart failure post MI

Thromboembolic disorder
The incidence of clinically evident systemic embolism after MI is less than 2%. This figure increases in patients with anterior wall MIs. The overall incidence of mural thrombus after MI is approximately 20%. Large anterior MI may be associated with mural thrombus in as many as 60% of patients

Rupture
- Papillary Muscle Rupture : 13 hours post MI - Ventricular Septal Rupture : 2-5 days post MI - Free Wall Rupture : within 2 weeks post MI

Aneurysm
Ventricular Aneurysm - an area of thin scar devoid of muscle that occurs after myocardial infarction. This area is well-delineated and both walls bulge outward during systole Morphology - A. The fibrous scar is transmural and delineated from surrounding myocardium - B. Underlying endocardium is smooth and nontrabeculated - C. The aneurysm is thin, devoid of muscle, and often large - D. The walls are akinetic or dyskinetic during systole

Ischemic Complications
Patients with infarct extension or post MI angina usually have continuous or recurrent chest pain, with protracted elevation in creatine kinase (CK) and occasional new ECG changes. CK-MB is a more useful marker for tracking on-going infarction than troponins, given their shorter half-life. Rising and falling CK-MB levels suggest infarct expansion or recurrent infarction.

Inflammatory and Immunologic Complications

Pericarditis : 1-8 weeks post MI in 10% Post cardiac injury syndrome (PCIS) = inflammation of the pericardium, pleura, and pulmonary parenchyma

Dresslers Syndrome
First described by a cardiologist born in Poland , William Dressler (18901969). Occurs in weeks to months in 1-3% of post MI patients The syndrome consists of a persistent low-grade fever, chest pain (usually pleuritic in nature), a pericardial friction rub, and /or a pericardial effusion. Signs include elevated ESR.