ACUTE CORONARY SYNDROME-COMPLICATIONS
SUMMARY
1. LV infarction.
2. RV infarction: usually caused by inferior MI. - Management of RVI is frequently diametrically opposed to that of LV infarction. Avoid nitrates & preload reducing agents, fluid support & inotropic support may be required.
3. Arrhythmias & blocks: AF, VT, VF.
- DC cardioversion for those with haemodynamic instability or pulseless VT.
- Medical mgm. in AF: digoxin, beta-blockers, diltiazem. Medical mgm. in VT: amiodarone, lidocaine, correct hypokalemia or hypomagnesemia.
- For patients who develop VT after first 48 hours: consider ICD.
- For non-sustained VT/VF lasting < 30 sec: consider beta-blockers.
4. Bradycardia & AV block: assoc. with inferior MI. May require ventricular pacing if: unresponsive to medical mgm, 3o heart block, Mobitz-type II 2o degree AV block, asystole.
5. Papillary muscle rupture: 3-7 days after inferior MI. Results in shock and pulmonary oedema. Diagnosed with echo (TOE). Requires urgent CT surgery.
6. VSD: 3-7 days after antero-septal MI. Diagnosed with echo (TOE). Requires urgent CT surgery.
7. Free-wall rupture: 3-7 days after anterior MI. Diagnosed with echo (TOE). Requires urgent CT surgery.
Reference(s)
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
