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Complications of Myocardial Infarction

QuestionsSunil Mankad, MD, FACC, FCCP, FASE

Associate Professor of MedicineMayo Clinic College of Medicine

Director, Transesophageal EchocardiographyAssociate Director, Cardiology Fellowship

Mayo Clinic, Rochester, MNmankad.sunil@mayo.edu

@MDMankad

DISCLOSUREDISCLOSURERelevant Financial Relationship(s)

None

Off Label UsageNone

Relevant Financial Relationship(s)None

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Q1. The post-MI image shown represents:A. LV pseudoaneurysmB. LV aneurysmC. Myocardial ruptureD. Finding with high risk of rupture

Q1. The post-MI image shown represents:A. LV pseudoaneurysmB. LV aneurysmC. Myocardial ruptureD. Finding with high risk of rupture

Q2: Post-MI dynamic LVOT obstruction is most commonly seen with:Q2: Post-MI dynamic LVOT obstruction is most commonly seen with:

A. Inferior myocardial infarctionB.Lateral myocardial infarctionC.Apical myocardial infarctionD.Posterior myocardial infarction

A. Inferior myocardial infarctionB.Lateral myocardial infarctionC.Apical myocardial infarctionD.Posterior myocardial infarction

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Q3: Which of the following is the most common cause of shock post myocardial infarction?

Q3: Which of the following is the most common cause of shock post myocardial infarction?A.Ventricular septal defectB.Cardiac tamponadeC.Mitral regurgitation secondary to

papillary muscle ruptureD.Shock secondary to pump failure

A.Ventricular septal defectB.Cardiac tamponadeC.Mitral regurgitation secondary to

papillary muscle ruptureD.Shock secondary to pump failure

Etiology of Cardiogenic Shock After Acute MIEtiology of Cardiogenic Shock After Acute MI

LV failure85%

Others RV infarct (2%)

VSD or MR8%

5%

Adapted from Hochman JS et al. Circulation 1995; 91:873-881

251 patients from 19 centers

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Q4: The incidence of LV thrombus development post-MI in patients with LV systolic dysfunction (EF < 40%) treated with PCI and dual antiplatelet therapy is approximately:

Q4: The incidence of LV thrombus development post-MI in patients with LV systolic dysfunction (EF < 40%) treated with PCI and dual antiplatelet therapy is approximately:

A.< 2%B.2-5%C.5-7%D.≥ 10%

A.< 2%B.2-5%C.5-7%D.≥ 10%

Q5: Recent data suggest that surgical mortality for papillary muscle rupture is approximately 10%. Which of the following is true?

Q5: Recent data suggest that surgical mortality for papillary muscle rupture is approximately 10%. Which of the following is true?

Survivors of patient undergoing papillary muscle rupture surgery have a long-term mortality:A. > than those post-MI patients that didn’t have a

papillary muscle ruptureB. < than those post-MI patients that didn’t have a

papillary muscle ruptureC. Similar to those post-MI patients that didn’t have

a papillary muscle rupture

Survivors of patient undergoing papillary muscle rupture surgery have a long-term mortality:A. > than those post-MI patients that didn’t have a

papillary muscle ruptureB. < than those post-MI patients that didn’t have a

papillary muscle ruptureC. Similar to those post-MI patients that didn’t have

a papillary muscle rupture

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Late survival in operative survivorsLate survival in operative survivors

Adapted from Russo et al.

Q6: A 63 year old female with the EKG below and a normal CXR suddenly develops hypoxia. What is the most likely cause of hypoxia?

Q6: A 63 year old female with the EKG below and a normal CXR suddenly develops hypoxia. What is the most likely cause of hypoxia?

A. Coexistent acute pulmonary embolusB. Mitral papillary muscle rupture with pulmonary edemaC. Right to left shunting through a patent foramen ovaleD. Methemoglobinemia

Right sided lead (RV4)

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Severe RV dysfunction, preserved LV function

Severe RV dysfunction, preserved LV function

Large PFOLarge PFO

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RV Infarct HypoxiaThink PFO

RV Infarct HypoxiaThink PFO

Severe Right to Left shunting

Status-post Right Ventricular Assist Device (RVAD)

Status-post Right Ventricular Assist Device (RVAD)