COMPLICATIONS OF AMI AND TREATMENT

1. TRICULAR DYSFUNCTION
2. RV INFARCTION
3. RUPTURE OF FREE WALL
4. CARDIOGENIC SHOCK
5. VENTRICULAR SEPTAL DEFECT (VSD)
6. MITRAL REGURGITATION (MR)

1. VENTRICULAR DYSFUNCTION

• Ventricular remodeling is a series of changes in shape, size and thickness of ventricular myocar­dium after infarction. This leads to global LV dys­function and CHF.

Killip’s classification of L V dysfunction:

• Class I – No pulmonary or venous congestion .
• Class II – Rales at lung bases, S3′ tachypnea,
• Right heart failure .
• Class III – Pulmonary edema.
• Class IV – Shock-systolic blood pressure <90
• mmHg.
• Mortality is upto 95% in class IV .

Treatment:

• Avoidance of hypoxaemia Diuresis
• Afterload reduction Inotropic support Digitalis
• Nitrates
• Topical NTG ointment
• IV NTG and ACE inhibitors.

2. RV INFARCTION

• There is RV failure – JVP raised, hepatomegaly, hypotension, ST elevation of right sided precor­dial leads – V₄ R.

Treatment:

• Volume expansion and treat LV dysfunction.

3. RUPTURE OF FREE WALL

• · Occurs specially in elderly
• · Large Q wave infarct
• · H/o hypertension
• · First time infarct
• Presents with : – Absent pulses
• – Unconsciousness
• – Cardiac tamponade.
• anagement – Surgical repair.

4. CARDIOGENIC SHOCK

• · This occurs due to severe LVF.
• · Systolic arterial pressure is <80 mmHg.
• · Cardiac index is < 1.8 It/min/m²•
• · Pulmonary capillary wedge pressure> 18
• mmHg.
• Cardiogenic shock occurs due to reduction of con­tractile myocardium, arrhythmias, metabolic acido­sis.

Treatment:

• Intraaortic balloon counter pulsation.
• A balloon is introduced via femoral artery into the aorta and inflated in diastole to augment coronary flow.
• Vasopressors
• Isoproterenoi
• Norepinephrine – 2 to 4 IJg/min
• Dopamine 2 – 10 IJg/kg/min up to 20 – 50 IJg/ kg/min
• It has vasoconstrictor effect but at low doses dilates the renal and splanchnic blood vessels
• Dobutamine – 2.5 to 10 IJg/kg/min
• It has positive inotropic action
• Amrinone
• Milrinone – They are very potent vasodilators and positive inotropic agents
• Aortic counter pulsation

5. VENTRICULAR SEPTAL DEFECT (VSD)

• There is severe LVF, systolic thrill in left paraster­nal area.

Treatment:

• Nitruprusside infusion Intra aortic pulsation.

6. MITRAL REGURGITATION (MR)

• Apical systolic murmurs appear due to papillary muscle dysfunction, LV dilatation, rupture of cusp.

Treatment:

• Decongestive therapy Afterload reduction
• ABC (Aortic balloon counter pulsation) NTG infusion and Surgical treatment.

SOME more complications are — complications-of-acute-myocardial-infarction-ami-and-treatment-2