Maximum mortality of MI occurs in day …? (LQ)
Complications of MI
1. Bradycardia or heart block:
a. Sinus bradycardia is very common in inferior wall MI: treat with atropine Q 0.6 -1.2mg, or injection isoprenaline
b. Consider temporary cardiac pacing if no response, or poorly tolerated by the patient.
c. 1st degree AV block: Observe closely as approximately 40% develop higher degrees of AV block.
d. 2nd degree (II A block) Wenckebach (Mobitz type I) block: Does not require pacing Q.
e. 2nd degree (II B block) Mobitz type II block: Carries a high risk of developing complete AV block; should be paced Q.
f. Complete AV block: insert pacemaker
g. Bundle branch block: MI complicated by trifascicular block or non-adjacent bifascicular disease should be paced.
Dofetilide: It is a pure K+ channel blocker, used for maintenance of sinus rhythm in symptomatic atrial flutter and fibrillation. It increase the refractory period of both atria and ventricles.
a. K+, hypoxia and acidosis Q all predispose to arrhythmias and should be corrected.
b. Regular broad complex tachycardia after MI is almost always VT.
c. If hemodynamically stable, treat with antidysrhythmic.
d. Early VT: give lidocaine by infusion for 12-24h or amiodarone.
e. Late VT (>24h) amiodarone and start oral therapy (amiodarone or sotalol)
f. If hemodynamically compromised give DC shock.
g. Af or flutter If hemodynamically compromised, DC cardioversion Otherwise control rate with digoxin or beta -blocker.
h. In atrial flutter or intermittent Af, give amiodarone or sotalol.