[Education] UMEM Educational Pearl: Cardiology

[amalmattu at comcast.net]

Rajesh, 
There's no specific reference I used. This is something I teach in board review courses and is probably found in the textbooks. You might find it if you read about post-MI complications. 

Hope that helps. 

Amal 

----- Original Message -----
From: "Rajesh Malik" <drrajeshmalik at gmail.com> 
To: HelpAccountadmin at umem.org 
Cc: education at lists.umem.org, amalmattu at comcast.net 
Sent: Tuesday, September 20, 2011 7:35:36 AM 
Subject: Re: [Education] UMEM Educational Pearl: Cardiology 

Dear Dr Mattu, 

Could I please get references on this PEARL. There are none coming up on the website. 

Thanks & Kind REgards, 

Rajesh Malik 


On Mon, Sep 19, 2011 at 7:15 AM, UMEM Webmaster < admin at umem.org > wrote: 


Title: post-MI complication 
Author: Amal Mattu 
[Click to email author] 


A patient presents to the ED in pulmonary edema, hypotensive , and has JVD . There's a new systolic murmur. The patient had an acute MI 7-10 days ago and had appropriate treatment and uncomplicated course, then discharge. What's the diagnosis and what do you do? 

Step 1: Sign out immediately. 

Step 2: If it's not time to sign out (just kidding about step 1), listen carefully to the murmur. If it's heard best at the lower sternal border, it's probably a ruptured papillary muscle with acute MR. If it's a "machinery" type murmur heard throughout the precordium loudly, it's probably an acute VSD . 

Step 3: VSD patient is likely to die, but with either one, you've got to move quickly. IMMEDIATELY call cardiology AND cardiac surgery. The patient is in need of a balloon pump and OR. 
All you can do is buy time until the patient goes upstairs....pressors for BP, IV NTG as tolerated for preload reduction, and be judicious with diuretics. Vasodilators might help unload the heart also. This patient may end up on 2-3 drips, and make sure ALL meds are titrateable . And just keep your fingers crossed! References 

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-- 
Rajesh Malik 
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