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Mechanical Complications of Acute Myocardial Infarction

  • Andras Peter Durko
  • Wouter Jacob van Leeuwen
  • Arie Pieter Kappetein
Chapter

Abstract

Mechanical complications are rare, however dreaded, and potentially lethal consequences of acute myocardial infarction (AMI). They manifest as a tear (rupture) of the necrotic myocardium with ventricular septal rupture (VSR), free wall rupture, and/or ischemic mitral regurgitation (IMR) as a consequence. The introduction and routine use of primary reperfusion therapies such as thrombolysis and especially primary PCI in the management of AMI have reduced the incidence of excessive myocardial necrosis and the subsequent rupture of the acutely ischemic myocardium. However clinicians can still expect to encounter this life-threatening entity in a minority (around 1%) of patients following AMI. As survival of medically treated patients is extremely poor, diagnosis of an acute/subacute event requires urgent surgical referral, and in most cases necessitates life-saving emergency surgery. Mortality after surgical treatment, however, is also high, rendering decision-making in this condition often complex and not always straightforward. Features of different mechanical complications are discussed in this chapter, but all combinations can be encountered in clinical practice.

Keywords

Acute myocardial infarction Mechanical complication Ventricular septal rupture (VSR) Papillary muscle rupture (PMR) Acute mitral regurgitation (MR) Free wall rupture (FWR) Cardiac tamponade ECLS Left ventricular aneurysm Pseudoaneurysm 

Notes

Acknowledgement

Disclosure statement: No conflicts of interest to report.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Andras Peter Durko
    • 1
  • Wouter Jacob van Leeuwen
    • 1
  • Arie Pieter Kappetein
    • 1
  1. 1.Erasmus Medical Centre, University Medical Center RotterdamRotterdamThe Netherlands

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