Management of Acute Myocardial Infarction

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Management of Acute Myocardial Infarction
Sivanandam Vasudevan
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Management of Acute Myocardial Infarction

• Pre Hospital Phase
• ER
• CCU
• Step-down - Telemetry
• Post Hospital Phase

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Complications of Acute Myocardial Infarction

• Arrhythmic Complications
• Mechanical Complications
• Ischemic Complications
• Miscellaneous Complications
• DVT, PE, Pericarditits, TPA complications,
  Pneumonia

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Arrhythmic ComplicationsEarly lt 24 hrs late
gt24 hrs

• Ventricular PVC, V tach/V Fib
• Atrial PAC, SVT, A Fib
• Bradycardia Sinus
• AV block Complete Heart Block
• LAFB, LPHB, LBBB RBBB

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Mechanical Complications of Acute Myocardial
Infarction

• Papillary Muscle Rupture Acute MR
• Ventricular Septal Defect
• Right Ventricular MI
• Free Wall Rupture
• Cardiogenic shock
• Cardiac Tamponade

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Hemodynamic findings in complications causing
cardiogenic shock with acute MI (a)

• Ac Pul edema
• Shock
• MR

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Mechanisms causing MR during an acute MI and
their treatment modalities
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Rupture of papillary muscle, a rare complication
of acute MI (a)
Rupture of papillary muscle, a rare complication
of acute MI (b)
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Transesophageal echocardiogram in the
four-chamber view
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Hemodynamic findings in complications causing
cardiogenic shock with acute MI (b)

• Ac Pul edema
• Shock
• Systolic murmur

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Ventricular Rupture VSR
Ventricular septal rupture (a)
Ventricular septal rupture (b)
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Hemodynamic findings in complications causing
cardiogenic shock with acute MI (c)

• CHF
• Clear lungs
• Hypotension
• Systolic murmur
• Inf. MI

ECG V4 R
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Hemodynamic findings in complications causing
cardiogenic shock with acute MI (d)
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Hemodynamic findings in complications causing
cardiogenic shock with acute MI (e)

• BP lt 90
• Tachycardia
• Pul edema
• Confused
• Skin cold clammy
• Ant. MI
• Mortality 80

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Regional acute MI, infarct expansion, chamber
thrombosis and aneurysm formation (a)
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Regional acute MI, infarct expansion, chamber
thrombosis and aneurysm formation (b)
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Regional acute MI, infarct expansion, chamber
thrombosis and aneurysm formation (c)
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Regional acute MI, infarct expansion, chamber
thrombosis and aneurysm formation (d)
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B
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Incidence of cardiogenic shock complicating acute
MI
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Rupture of the heart complicates acute MI in
about 10 of cases
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Ischemic Complications Post Myocardial
InfarctionChest pain Post MI

• Recurrent angina
• Recurrent MI
• Pericarditis Acute Dresslers
• Pneumonia
• Pulmonary Embolism
• Shoulder hand syndrome

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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

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Management of Acute Myocardial Infarction
Thank You