Complications of Myocardial Infarction
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 29 April 2018
⏱️ 10 minutes
🧾️ Download transcript
Summary
Mnemonic: DARTH VADER
Death
Arrhythmia
* ACS patients need to be placed on cardiac monitor* Frequently degenerate into non-perfusing rhythms
Rupture of Ventricle
* Occur within a few days of myocardial infarction* Rapid decompensation* Bedside ultrasound will show pericardial effusion and tamponade
Tamponade
* Multiple etiologies* Rupture of ventricle (see above)* Pericarditis* Becks Triad* Jugular vein distension* Muffled heart sounds* Hypotension* Diagnosed with bedside ultrasound* Treatment is pericardiocentesis
Heart Failure
* Occurs in approximately 1/3 post-MI patients* Leads to cardiogenic shock* Treatment* Fluid bolus* Vasopressors (esp. norepinephrine)* Inotropes (milrinone, dobutimine)* Left ventricular assist devices* Intra-aortic balloon pumps
Valve Failure/Rupture
* Rapid decompensation (similar to ventricular wall rupture)* PLUS* New heart murmur* Surgical emergency
Aneurysm
* A classic STEMI mimic* Large Q waves with ST segment elevation (IN ASYMPTOMATIC PATIENT)
Dresslers Syndrome/Pericarditis
* Rule out cardiac tamponade* Treatment* NSAIDS/colchicine
Embolism
* Occur in damaged ventricles and in cardiac aneurysms* Require anticoagulation
Recurrence
* Emphasize lifestyle management
Additional Reading
* Approach to STEMI (EM Clerkship)
Transcript
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| 0:00.0 | Hello, med students. My name is Zach Olson, and thank you for downloading this week's episode of the EM Clerkship Podcast. |
| 0:11.0 | Big episode this week. Today, I'm going to teach you about heart attack complications, the whole list. |
| 0:18.8 | This is kind of part two to our STEME episode. Anybody who is having an |
| 0:24.4 | MI or recently had a heart attack, even if they got stented or whatever, you still need an |
| 0:31.4 | organized approach for how to think the rest of the way, all the way through that case. |
| 0:40.7 | It does not end with aspirin, |
| 0:46.9 | plavix, heparin, cath. Cognitively, there's a next level to this, which I want us to learn. |
| 0:53.0 | It is another mnemonic episode. Sorry if you don't like mnemonics. this is the Darth Vader mnemonic for complications of |
| 0:55.1 | MI. |
| 0:56.0 | Fairly well known as far as I can tell. |
| 0:58.9 | Darth Vader. |
| 0:59.8 | The complications of MI are death, erythmia, rupture of the ventricle, tamponod, heart failure, and then Vader, valve failure, aneurism, |
| 1:20.0 | Dressler syndrome slash paracarditis, embolism, and then recurrence of the MI. It's a long list. All I want you to remember today is that the |
| 1:32.4 | Darth Vader mnemonic exists. We'll be sure to get this into the show notes so that when you do |
| 1:37.9 | run into one of these cases, whether it's during your clerkship or in residency, you can look |
| 1:42.9 | everything back up quickly and then go through this again. |
| 1:46.6 | So starting from the top, Darth Vader. |
| 1:50.8 | D. |
| 1:51.9 | Death. |
| 1:52.9 | Okay, obvious. |
| 1:53.9 | Let's save some time here. |
| 1:55.2 | All of those cardiac arrests that are coming into the department, CPR in progress. |
... |
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