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Management of Acute Myocardial Infarction

Management of Acute Myocardial Infarction. Sivanandam Vasudevan . Management of Acute Myocardial Infarction. Pre Hospital Phase ER CCU Step-down - Telemetry Post Hospital Phase. Complications of Acute Myocardial Infarction. Arrhythmic Complications Mechanical Complications

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Management of Acute Myocardial Infarction

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  1. Management of Acute Myocardial Infarction Sivanandam Vasudevan

  2. Management of Acute Myocardial Infarction • Pre Hospital Phase • ER • CCU • Step-down - Telemetry • Post Hospital Phase

  3. Complications of Acute Myocardial Infarction • Arrhythmic Complications • Mechanical Complications • Ischemic Complications • Miscellaneous Complications • [DVT, PE, Pericarditits, TPA complications, Pneumonia]

  4. Arrhythmic Complications[Early < 24 hrs & late >24 hrs] • Ventricular – PVC, V tach/V Fib • Atrial – PAC, SVT, A Fib • Bradycardia – Sinus • AV block – Complete Heart Block • LAFB, LPHB, LBBB & RBBB

  5. Mechanical Complications of Acute Myocardial Infarction • Papillary Muscle Rupture – Acute MR • Ventricular Septal Defect • Right Ventricular MI • Free Wall Rupture • Cardiogenic shock • Cardiac Tamponade

  6. Hemodynamic findings in complications causing cardiogenic shock with acute MI (a) • Ac Pul edema • Shock • MR

  7. Mechanisms causing MR during an acute MI and their treatment modalities

  8. Rupture of papillary muscle, a rare complication of acute MI (a) Rupture of papillary muscle, a rare complication of acute MI (b)

  9. Transesophageal echocardiogram in the four-chamber view

  10. Hemodynamic findings in complications causing cardiogenic shock with acute MI (b) • Ac Pul edema • Shock • Systolic murmur

  11. Ventricular Rupture [VSR] Ventricular septal rupture (a) Ventricular septal rupture (b)

  12. Hemodynamic findings in complications causing cardiogenic shock with acute MI (c) • CHF • Clear lungs • Hypotension • Systolic murmur • Inf. MI ECG V4 R

  13. Hemodynamic findings in complications causing cardiogenic shock with acute MI (d)

  14. Hemodynamic findings in complications causing cardiogenic shock with acute MI (e) • BP < 90 • Tachycardia • Pul edema • Confused • Skin cold clammy • Ant. MI • Mortality 80%

  15. Regional acute MI, infarct expansion, chamber thrombosis and aneurysm formation (a)

  16. Regional acute MI, infarct expansion, chamber thrombosis and aneurysm formation (b)

  17. Regional acute MI, infarct expansion, chamber thrombosis and aneurysm formation (c)

  18. Regional acute MI, infarct expansion, chamber thrombosis and aneurysm formation (d)

  19. B

  20. Incidence of cardiogenic shock complicating acute MI

  21. Rupture of the heart complicates acute MI in about 10% of cases

  22. Ischemic Complications Post Myocardial InfarctionChest pain Post MI • Recurrent angina • Recurrent MI • Pericarditis[ Acute & Dressler’s ] • Pneumonia • Pulmonary Embolism • Shoulder hand syndrome

  23. 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

  24. Management of Acute Myocardial Infarction Thank You

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