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Mnemonic: DARTH VADER
Death
Arrhythmia
- ACS patients need to be placed on cardiac monitor
- Frequently degenerate into non-perfusing rhythms
Rupture of Ventricle
- Occur within a few days of myocardial infarction
- Rapid decompensation
- Bedside ultrasound will show pericardial effusion and tamponade
Tamponade
- Multiple etiologies
- Rupture of ventricle (see above)
- Pericarditis
- Becks Triad
- Jugular vein distension
- Muffled heart sounds
- Hypotension
- Diagnosed with bedside ultrasound
- Treatment is pericardiocentesis
Heart Failure
- Occurs in approximately 1/3 post-MI patients
- Leads to cardiogenic shock
- Treatment
- Fluid bolus
- Vasopressors (esp. norepinephrine)
- Inotropes (milrinone, dobutimine)
- Left ventricular assist devices
- Intra-aortic balloon pumps
Valve Failure/Rupture
- Rapid decompensation (similar to ventricular wall rupture)
- PLUS
- New heart murmur
- Surgical emergency
Aneurysm
- A classic STEMI mimic
- Large Q waves with ST segment elevation (IN ASYMPTOMATIC PATIENT)
Dresslers Syndrome/Pericarditis
- Rule out cardiac tamponade
- Treatment
- NSAIDS/colchicine
Embolism
- Occur in damaged ventricles and in cardiac aneurysms
- Require anticoagulation
Recurrence
- Emphasize lifestyle management
Additional Reading
- Approach to STEMI (EM Clerkship)
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