Mechanical complications

Mechanical complications (incid. <1% for each; typically occur a few days post-MI)

• Free wall rupture: ↑ risk w/ lysis, large MI, ↑ age, ♀, HTN; p/w PEA or hypoTN, pericardial sx, tamponade; Rx: volume resusc., ? pericardiocentesis, inotropes, surgery

• VSD: large MI in elderly; AMI → apical VSD, IMI → basal septum; 90% w/ harsh murmur ± thrill (NEJM 2002;347:1426); Rx: diuretics, vasodil., inotropes, IABP, surgery, perc. closure

• Papillary muscle rupture: more common after IMI (PM pap m. supplied by PDA alone) than AMI (AL supplied by OMs & diags); 50% w/ new murmur; ↑ v wave in PCWP tracing; asymmetric pulmonary edema on CXR. Rx: diuretics, vasodilators, IABP, surgery.