What are the risk factors and other complications involved myocardial infarction

Complications

In the acute phase the first 2 or 3 days following MI cardiac arrhythmias, cardiac failure and pericarditis are the most common complications.

Later, recurrent infarction, angina, thromboembolism, mitral valve, regurgitation and ventricular septal or free wall rupture may occur. Late complications include the post – MI syndrome, ventricular aneurysm, and recurrent cardiac arrhythmias.

Ventricular Extra systoles

These commonly occurs after MI. Their occurrence may precede the development of ventricular fibrillation, particularly if they are frequent or R on T (falling on the upstroke or peak of the preceding T wave) Treatment has not been shown to reduce the like hood of subsequent ventricular tachycardia or fibrillation.

Sustained Ventricular tachycardia

This may degenerate in to ventricular fibrillation or may itself produce serious haemodynamic consequences. It can be treated with intravenous lidocaine or, if haemodynamic deterioration occurs, synchronized cardio version.

Ventricular Fibrillation

This may occur in the first few hours or days following an MI in the absences or server cardiac failure or carcinogenic shock . It is treated with prompt defibrillation.

Recurrences of ventricular fibrillation can be treated with lidocaine infusion or, in cases of poor left ventricular function, amiodarone. When ventricular fibrillation occurs in the setting of heart failure , shock or aneurysm.

The prognosis is very poor unless the underlying haemodynamic or mechanical cause can be corrected. The serum potassium should be above 4.5 mmol/L.

Atrial Fibrillation

This occurs in about 10% of patients with MT. It is due to atrial irritation caused by heart failure, pericarditis and atrial ischaemia or infarction.

It maybe managed with intravenous digoxin (to reduce ventricular rate 1-2h) or intravenous amiodarone and by treatment of the underlying amiodarone and by treatment of the underlying pathology. It is not usually a long-standing problem, but it is risk factors for subsequent mortality

Sinus Bradycardia.

This is especially associated with acute inferior wall MI. Symptoms emerge only when the Bradycardia is severe. When symptomatic, the treatment consists of elevating the foot of the bed and giving intravenous stropine, 600ug if no improvement.

When sinus Bradycardia occurs, an escape rhythm such as idioventricular rhythm or idiojunctional rhythm may occur. Usually no specific treatment is required. it has been suggested that sinus.

Bradycardia following MI may predispose to the emergence of ventricular fibrillation. Serve sinus Bradycardia associated with unresponsive symptoms or the emergence of unstable rhythms may need treatment with temporary pacing.

Sinus tachycardia

This is produced by heart failure, fever and anxiety. Usually no specific treatment is required.

Clinical Classification of heart failure in patients with acute myocardial infarction

Class Description Incidence (%) Mortality (%)
1 No heart failure 40 5
2 Mild Left Ventricular failure ` 40 20
3 Pulmonary Oedema 10 40
4 Cardiogenic Shock 10 90

 

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