University of Miami, Jackson Memorial Hospital/Miller School of Medicine, Department of Emergency Medicine, 1611 N.W. 12th Avenue, Miami, FL 33136, United States.
Brooke Army Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
Am J Emerg Med. 2019 Jun;37(6):1175-1183. doi: 10.1016/j.ajem.2019.04.003. Epub 2019 Apr 8.
Despite the declining incidence of coronary heart disease (CHD) in the United States, acute myocardial infarction (AMI) remains an important clinical entity, with many patients requiring emergency department (ED) management for mechanical, inflammatory, and embolic complications.
This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post myocardial infarction mechanical, inflammatory, and embolic complications.
While 30-day mortality rate after AMI has decreased in the past two decades, it remains significantly elevated at 7.8%, owing to a wide variety of subacute complications evolving over weeks. Mechanical complications such as ventricular free wall rupture, ventricular septal rupture, mitral valve regurgitation, and formation of left ventricular aneurysms carry significant morbidity. Additional complications include ischemic stroke, heart failure, renal failure, and cardiac dysrhythmias. This review provides several guiding principles for management of these complications. Understanding these complications and an approach to the management of various complications is essential to optimizing patient care.
Mechanical, inflammatory, and embolic complications of AMI can result in significant morbidity and mortality. Physicians must rapidly diagnose these conditions while evaluating for other diseases. In addition to understanding the natural progression of disease and performing a focused physical examination, an electrocardiogram and bedside echocardiogram provide quick, noninvasive determinations of the underlying pathophysiology. Management varies by presentation and etiology, but close consultation with cardiology and cardiac surgery is recommended.
尽管美国冠心病（CHD）的发病率正在下降，但急性心肌梗死（AMI）仍然是一个重要的临床实体，许多患者需要在急诊室（ED）管理机械、炎症和栓塞并发症。
本叙述性综述提供了心肌梗死后机械、炎症和栓塞并发症的急诊医学评估和管理的当前数据的循证总结。
尽管过去二十年来 AMI 的 30 天死亡率有所下降，但由于在数周内出现了多种亚急性并发症，其死亡率仍显著升高，为 7.8%。机械并发症，如心室游离壁破裂、心室间隔破裂、二尖瓣反流和左心室动脉瘤形成，具有显著的发病率。其他并发症包括缺血性中风、心力衰竭、肾衰竭和心律失常。本综述提供了这些并发症的管理的几个指导原则。了解这些并发症和处理各种并发症的方法对于优化患者的护理至关重要。
AMI 的机械、炎症和栓塞并发症可导致显著的发病率和死亡率。医生在评估其他疾病的同时，必须迅速诊断这些疾病。除了了解疾病的自然进程和进行重点体检外，心电图和床边超声心动图可快速、无创地确定潜在的病理生理学。管理方法因表现和病因而异，但建议与心脏病学和心脏外科密切协商。
