90 develop some form of cardiac arrhythmia 25 of

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90% develop some form of cardiac arrhythmia. 25% of patients rhythm abnormalities manifest within the first 24 hours Risk of VF is greatest in the first hour and declines thereafter. The incidence increases with an STEMI and decreases with NSTEMI. Reperfusion strategies used to avoid ischemia and subsequent hemodynamic compromise. Most peri-infarct arrhythmias are benign however, they can lead to malignant ventricular arrhythmias. Medscape.com
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Mechanical Complications 3 major mechanical complications which can cause cardiogenic shock are: Ventricular free wall rupture Laceration or tearing of the ventricular wall, of the papillary muscles, of the chordae tendinae, or the valves. Ventricular septal rupture Laceration or tearing of the septal wall Papillary muscle rupture with severe mitral regurgitation Papillary muscle tears collapsing the chordae tendinae leading to valve prolapse/inversion. Medscape.com
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Schoen FJ, Saunders, 1989 Cardiac Rupture Syndromes Complications of Myocardial Infarction Papillary Muscle Rupture Ventricular Aneurysm Dr. William D. Edwards, Mayo Clinic, Rochester, MN. USA
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Left Ventricular Aneurysms Defined as a localized area of myocardium with abnormal outward bulging . Risk factors for these aneurysms after acute myocardial infarction include the following: Female Total occlusion of the LAD artery Single-vessel disease Absence of previous angina Ventricular aneurysms Medscape.com
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Pseudoaneurysms Bulging/Ballooning of the ventricles are seen. Are confirmed by means of echocardiography, MRI, or contrast-enhanced CT scanning. Imaging of a pseudoaneurysm typically shows a relatively narrow neck and a complete absence of muscle in the wall of the pseudoaneurysm . Medscape.com
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Ventricular Septal Ruptures Rare, but a lethal complication Tearing of the interventricular septum Occurs 2-8 days after an infarction Concomitant coronary artery bypass may be required. Mortality rate is greater than 90%. Ventricular rupture is more common in women, patients receiving non steroidal anti- inflammatory drugs (NSAIDs) or steroids. An echocardiogram is used to define the abnormality Medscape.com
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Schoen FJ: Interventional & Surgical Cardiovascular Pathology: Clinical Correlations & Basic Principles. Philadelphia, Saunders, 1989 Cardiac Rupture Syndromes Complications of Myocardial Infarction Anterior Myocardial Rupture Interventricular Septum Rupture
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Associated Right Ventricular Infarction Approx 1/3 of patients with inferior myocardial infarction develop RV infarction . A right-sided ECG with greater than 1 mm ST elevation in V 3 R or V 4 R leads describes an RV infarct. PE signs of right heart failure are elevated jugular venous pulsation, right-sided S 3 , Kussmaul sign, or hypotension.
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