Mechanical Complications in Acute MI

This infographic highlights the acute to subacute mechanical complications following myocardial infarction (MI), emphasizing the importance of thorough clinical and echocardiographic assessments, especially in patients presenting with new murmurs, recurrent chest pain, or cardiogenic shock.

• Acute LV/RV Dysfunction
  • Involves abnormalities in wall motion, systolic/diastolic function, and valvular hemodynamics.
  • Careful imaging is needed to evaluate these changes, with more infographics coming on this topic.
• Ventricular Free Wall Rupture
  • Presents with large or expanding pericardial effusion, leading to tamponade.
  • Frequently occurs in anterior infarcts. Use color Doppler to localize the tear.
  • Associated with high mortality; immediate diagnosis and intervention are crucial.
• Ventricular Septal Rupture
  • Common sites: basal inferoseptal wall (inferior infarct) and anteroapical wall (anterior infarct).
  • Requires off-axis imaging and Doppler assessment to identify the rupture.
  • Poor prognosis if associated with pulmonary hypertension or biventricular dysfunction.
• Papillary Muscle Rupture and Ischemic Mitral Regurgitation (MR)
  • Often involves the posterior papillary muscle, affecting leaflet coaptation.
  • Severe MR features include EROA ≥ 20 mm² and RVol ≥ 30 mL.
  • Ischemic MR is typically brief, influenced by LV afterload and reflected in mitral E velocity.
• Ventricular Pseudoaneurysm
  • Involves a contained rupture, most commonly along the inferior or inferolateral walls.
  • Characterized by a narrow neck and turbulent flow on Doppler imaging.
  • Risk of thrombosis within the pseudoaneurysm due to stasis.
• Ventricular Aneurysm
  • Typically associated with anterior infarctions and involves expansion instead of contraction during systole.
  • May harbor thrombus, requiring contrast echocardiography for further evaluation.

These mechanical complications, though less common in the reperfusion era, require vigilance for early detection and management to prevent further clinical deterioration.

Produced by Dr. Eunice Dugan and Dr. Karan Desai

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