Myocardial infarction

1- Early complications:

A- rhythm disorders (very common in the early hours):

– Sinus bradycardia, especially in cases of inferior infarction with sweat, pallor, fall in blood pressure (vagal syndrome); reversible under atropine and fluid replacement.

– Sinus tachycardia: common suggestive of left ventricular failure, extensive necrosis.

– AC / FA: frequent and transient risk of embolism. Atrial extension of necrosis or hemodynamic decompensation.

– Ventricular extrasystoles (VES): very common, especially in cases of recanalization (thrombolysis); requires immediate treatment if they are numerous, polymorphic, burst, near the T wave (appearance R / T).

– Ventricular tachycardia: wide QRS complex tachycardia regularly with P wave dissociated fusion events and capturing.

– Ventricular fibrillation

– Idioventricular rhythm accelerated (RIVA) performs a tachycardia with wide QRS appearance ventricular rate <120 / min; usually well tolerated and no adverse prognostic significance.

– Reperfusion syndrome: combines ESV, TV, RIVA sometimes bradycardia.

B- Conduction abnormalities:

– Sinoatrial block: especially in cases of inferior infarction; favored by the beta-blocker treatment; often poorly tolerated.

– BAV at a lower necrosis: progressive installation; well tolerated; QRS end; Relatively fast CF; Transitional good prognosis (reflecting edematous reaction).

– AVB during a previous necrosis: sudden onset; reflecting a low exhaust located; complex and wide QRS slow; risk of syncope; severe prognosis as reflecting an extensive infarction.

C- Heart failure:

– Killip classification (VIP):

* Class I: absence of crackles and B3

* Class II: pulmonary crackles dating back to mid-field or B3

* Class III: crackles back beyond with OAP

* Class IV: cardiogenic shock

– Primary Cardiogenic shock => necrosis> 40%

– Right ventricular failure (rare); she look for: a rupture of the interventricular septum, pulmonary embolism, pericardial tamponade; right ventricular extension of a lower infarction.

D- Mechanical complications:

– Septal rupture with CIV: complicates prior or infero- basal infarction. Holosystolic breath red circle and signs of acute congestive heart failure.

– Break or malfunction of ischemic mitral pillar: especially in cases of inferior infarction; shock, apexo-axillary systolic murmur, OAP. Capillary wave V at catheterization.

– Out of the free LV wall pain, shock, cracking syndrome (reappearance of a current above-epicardial injury?);éltromécanique dissociation;


2- Late complications:

– Dressler’s syndrome: after the third week; inspiratory pain and recurrent fever, joint pain, pericardial friction; common pleural effusion;mild but long evolution NSAID with the possibility of relapse.

– Ventricular Aneurysm: especially after anterior-apical infarction;diagnosed by double shock peak on palpation (inconstant); persistent lesion current subepicardial after 3 weeks (ST segment elevation). Risk of thrombus adhering; peripheral embolism; severe ventricular rhythm disorders; heart failure, rupture.

– Recurrent angina: requires coronary angiography for possible surgery

– Scapulohumeral periarthritis (shoulder-hand syndrome) -> dystrophy?