Mechanical complications of acute myocardial infarction
- Roger J Laham, MD
Roger J Laham, MD
- Associate Professor of Medicine
- Harvard Medical School
- Michael Simons, MD
Michael Simons, MD
- Robert W Berliner Professor of Medicine
- Yale University School of Medicine
- Rakesh M Suri, MD, DPhil
Rakesh M Suri, MD, DPhil
- Professor of Surgery
- Cleveland Clinic
There are three major mechanical complications of acute myocardial infarction (MI): rupture of the left ventricular free wall; rupture of the interventricular septum; and the development of mitral regurgitation. One study compared 225 patients who had a first MI and experienced one of these complications to 1012 patients with a first MI without these mechanical complications . Delayed hospitalization (≥24 hours), undue in-hospital physical activity, and postinfarction angina increased the risk of rupture in predisposed patients.
The clinical issues related to these mechanical problems, each of which can result in cardiogenic shock, will be reviewed here. (See "Clinical manifestations and diagnosis of cardiogenic shock in acute myocardial infarction".)
In this topic MI will refer to ST elevation MI, unless otherwise indicated.
RUPTURE OF THE LEFT VENTRICULAR FREE WALL
Acute or subacute myocardial rupture is a serious and often lethal complication of ST elevation myocardial infarction (STEMI) .
Incidence — Rupture of the free wall of the infarcted ventricle is a relatively common finding in patients dying with an acute myocardial infarction (MI). Several large studies have found cardiac rupture in 14 to 26 percent of such patients (picture 1) [3,4]. The incidence is much lower when all patients with acute MI are considered. As an example, the National Registry of Myocardial Infarction published data on 350,755 patients in 1996 . The following observations were noted:
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- RUPTURE OF THE LEFT VENTRICULAR FREE WALL
- Risk factors
- Effect of reperfusion
- - Late reperfusion
- Clinical presentation
- RUPTURE OF THE INTERVENTRICULAR SEPTUM
- Risk factors
- Effect of reperfusion
- Site of rupture
- Clinical manifestations
- ACUTE MITRAL REGURGITATION
- Silent MR
- Papillary muscle rupture
- - Diagnosis
- - Treatment
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS