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Complications of Myocardial Infarction

  • Brandon M. Jones
  • Venu MenonEmail author
Chapter

Abstract

This is a case of a 61 year old woman with chest discomfort and evidence of an inferior, ST-elevation myocardial infarction, who develops persistent cardiogenic shock and respiratory failure after primary percutaneous coronary intervention. We discuss the differential diagnosis for cardiogenic shock after acute myocardial infarction (AMI) including left ventricular failure, right ventricular failure, iatrogenic causes such as over-medication or bleeding complications, and mechanical complications of AMI including ventricular septal rupture (VSR), papillary muscle rupture, and free-wall rupture with cardiac tamponade. We focus on modalities for making the diagnosis including physical exam findings, trans-thoracic echocardiography, left ventriculogram, and right-heart catheterization. Medical as well as surgical management is discussed. Finally, we explore the controversial aspects regarding the evidence for intra-aortic balloon pump use in patients with cardiogenic shock after AMI, the optimal timing of surgical repair for VSR, and percutaneous options for VSR closure.

Keywords

Myocardial infarction Cardiogenic shock Mechanical complication Ventricular septal rupture VSR Papillary muscle rupture Cardiac tamponade Intra-aortic balloon pump IABP 

Supplementary material

Video 13.1

Apical ventricular septal rupture: A trans-thoracic, apical 4-chamber view of the heart showing the shunting of blood from the left ventricle to the right ventricle across an apical ventricular septal rupture in a patient with recent myocardial infarction. The patient underwent emergent surgical repair (AVI 1326 kb)

Video 13.2

Papillary muscle rupture: A trans-esophageal, mid-esophageal 4-chamber view of the heart showing rupture and flail of the papillary muscle into the left atrium. Color Doppler confirmed severe 4+ mitral regurgitation, and the patient underwent emergent surgery (AVI 3601 kb)

Video 13.3

Pre-tamponade after acute myocardial infarction: A trans-thoracic, apical 4-chamber view of the heart showing a patient with pre-tamponade physiology after the development of chest pain and ST changes. The echocardiogram demonstrated atrial inversion and diastolic collapse of the right ventricle. Pericardiocentesis showed a large, hemorrhagic effusion (AVI 4141 kb)

Video 13.4

Severe mitral regurgitation due to restriction of the posterior leaflet: A trans-thoracic, parasternal long-axis view of the heart in a patient with a prior inferior myocardial infarction. The inferior wall is akinetic resulting in restricted motion of the posterior mitral leaflet and severe mitral regurgitation (AVI 1928 kb)

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Cardiovascular Medicine and Interventional CardiologyCleveland Clinic FoundationClevelandUSA
  2. 2.Pulmonary and Critical CareGeisinger Medical CenterDanvilleUSA

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