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Mural thrombi are common in large anterior infarctions but not in infarctions at other locations Arterial emboli occur in approximately 2% of patients with known infarction, usually within 6 weeks Anticoagulation with heparin followed by short-term (3-month) warfarin therapy prevents most emboli and should be considered in all patients with large anterior infarctions Mural thrombi can be detected by echocardiography or CT scan (MRI has yielded frequent false-positive results) but with only moderate reliability, and only a small percentage (up to 25%) embolize, so these procedures should not be relied upon for determining the need for anticoagulation

Crenshaw BS et al Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators Circulation 2000 Jan 4 11;101 (1):27 32 [PMID: 10618300] Hochman JS et al Early revascularization in acute myocardial infarction complicated by cardiogenic shock SHOCK Investigators Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock N Engl J Med 1999 Aug 26; 341(9):625 34 [PMID: 10460813] Menon V et al Management of cardiogenic shock complicating acute myocardial infarction Heart 2002 Nov;88(5):531 7 [PMID: 12381652] Pfisterer M Right ventricular involvement in myocardial infarction and cardiogenic shock Lancet 2003 Aug 2;362 (9381): 392 4 [PMID: 12907014]

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Complete rupture of the LV free wall occurs in less than 1% of patients and usually results in immediate death It occurs 2 7 days postinfarction, usually involves the anterior wall, and is more frequent in older women Incomplete or gradual rupture may be sealed off by the pericardium, creating a pseudoaneurysm This may be recognized by echocardiography, radionuclide angiography, or LV angiography, often as an incidental finding It demonstrates a narrow-neck connection to the LV Early surgical repair is indicated, since delayed rupture is common

An LV aneurysm, a sharply delineated area of scar that bulges paradoxically during systole, develops in 10 20% of patients surviving an acute infarction This usually follows anterior Q wave infarctions Aneurysms are recognized by persistent STsegment elevation (beyond 4 8 weeks), and a wide neck from the LV can be demonstrated by echocardiography, scintigraphy, or contrast angiography They rarely rupture but may be associated with arterial emboli, ventricular arrhythmias, and CHF Surgical resection may be performed for these indications if other measures fail The best results (mortality rates of 10 20%) are obtained when the residual myocardium contracts well and when significant coronary lesions supplying adjacent regions are bypassed

Sales Documents | Schedule Lines | Assign Schedule Line Categories The schedule line category may be changed manually to any of the manual options entered in this screen The number of manual assignments shown on screen is four values, as seen in Figure 3-19 However, if you select the line and select details you will be able to define up to nine manual values

After the first 24 hours, the focus of patient management is to prevent recurrent ischemia, improve infarct healing and prevent remodeling, and prevent recurrent vascular events

purely for secondary prevention Antiarrhythmic therapy other than with -blockers has not been shown to be effective except in patients with symptomatic arrhythmias Amiodarone has been studied in several trials of postinfarct patients with either LV dysfunction or frequent ventricular ectopy Although survival was not improved, amiodarone was not harmful unlike other agents in this setting Therefore, it is the agent of choice for individuals with symptomatic postinfarction supraventricular arrhythmias While implantable defibrillators improve survival for patients with postinfarction LV dysfunction and heart failure, the DINAMIT trial found no benefit to implantable defibrillators implanted in the 40 days following acute myocardial infarction Cardiac rehabilitation programs and exercise training can be of considerable psychological benefit and appear to improve prognosis

Patients with hemodynamic compromise, who are at high risk for death, need careful monitoring and management of volume status

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