Mechanical Complications in Acute Myocardial Infarction Acute LV/RV Dysfunction: • Regional wall motion, systolic and diastolic function, chamber size and valvular hemodynamics • Many more findings but see separate upcoming infographics! Ventricular Free Wall Rupture: • Large pericardial effusion or expanding pericardial effusion along areas of wall thinning • Features of tamponade • Fibrinous echodensities in pericardial space (blood) • Color Doppler to localize tear • Typically anterior infarct Ventricular Septal Rupture: • Most common locations: basal inferoseptal wall (inferior infarct) and anteroapical (anterior infarct) • Color Doppler with lower Nyquisit limit to localize • Off-axis imaging may be needed • Evaluate for Pulm. HTN and LV/RV dysfunction = poor prognostic signs Papillary Muscle Rupture and Ischemic MR: • Posterior papillary muscle (inferior or lateral MI) most commonly affected • Assess severity of MR and leaflet motion (prolapse or flail?). Highly sensitive to afterload • Severe ischemic MR parameters: EROA ≥ 20 mm2 and Rvol ≥ 30 mL • MR likely to be eccentric and brief in duration (↑ LA pressure). • Typically ↑ mitral E velocity. Ventricular Pseudoaneurysm • Contained rupture along LV free wall; most commonly inferior and inferolateral walls • Small, narrow neck; ratio of neck diameter to max aneurysm size < 0.5 • Bidirectional color and spectral doppler flow through aneurysm neck • Stasis and thrombus in pericardial space Ventricular Aneurysm: • Most frequently with anterior infarct in apical region • Acute aneurysm expands (instead of contracts) during systole • May be associated with thrombus (laminar or pedunculated) • May need contrast echo to identify - Karan Desai MD @karanpdesai via CardioNerds @cardionerds #Complications #Myocardial #Infarction #acuteMI #cardiology #differential #diagnosis #timeline
