IDENTIFICATION AND TREATMENT OF COMPLICATIONS OF MYOCARDIAL-INFARCTION

Mechanical complications of acute myocardial infarction include papill ary muscle rupture with severe mitral regurgitation, ventricular septa l rupture with acute ventricular septal defect, acute and subacute fre e-mall rupture, and hemodynamically significant right ventricular infa rction. Although such complications are infrequent, their importance i s underscored because of the potential ability to correct them with ea rly diagnosis and appropriate treatment. The diagnosis necessitates a high degree of suspicion based on clinical clues and rapid diagnostic testing. Bedside two-dimensional echocardiography, sometimes with tran sesophageal echocardiography, is most commonly used to diagnose or exc lude these complications. Patients suspected of having a mechanical co mplication of myocardial infarction should be urgently transferred to a medical center experienced in the management of these problems. For deteriorating patients without identifiable mechanical complications, coronary angiography and reperfusion with direct angioplasty should be considered.