Sandbox/00019

Features of mechanical complications in ST elevation MI

Feature	Mechanical Complication of ST Elevation Myocardial Infarction
	Papillary Muscle Rupture	Ventricular Septal Rupture	Free-Wall Rupture
Physical Findings	Soft pansystolic murmur best audible at the apex with radiation to the axilla, ⊖ precordial thrill, variable signs of RV overload	Harsh pansystolic murmur best audible at the lower left sternal border with radiation to the right precordium, ⊕ precordial thrill, S3, accentuated second heart sound	Diminished heart sounds, jugular venous distention, pulsus paradoxus
Echocardiographic Findings	Hypercontractile LV, torn papillary muscle or chordae tendineae, flail leaflet, severe mitral regurgitation	Left-to-right shunt at the ventricular level, pattern of RV overload	Layered high-acoustic echoes within the pericardium, pericardial effusion, RA and RV diastolic collapse, dilated inferior vena cava, and marked respiratory variations in mitral and tricuspid inflow
Hemodynamic Profiles	No oxygen saturation gradient from the RA to RV, large V waves in pulmonary artery and capillary wedge tracings, high pulmonary-capillary wedge pressure	Equalization of diastolic pressures among the cardiac chambers	Step-up in oxygen saturation between the RA and RV or PA, large V waves