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



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