Dysrhythmias and heart failure complicating acute myocardial infarction: An emergency medicine review

William T. Davis, Tim Montrief, Alexander Koyfman, Brit Long

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Introduction: Patients with acute myocardial infarction (AMI) may suffer several complications after the acute event, including dysrhythmias and heart failure (HF). These complications place patients at risk for morbidity and mortality. Objective: This narrative review evaluates literature and guideline recommendations relevant to the acute emergency department (ED) management of AMI complicated by dysrhythmia or HF, with a focus on evidence-based considerations for ED interventions. Discussion: Limited evidence exists for ED management of dysrhythmias in AMI due to relatively low prevalence and frequent exclusion of patients with active cardiac ischemia from clinical studies. Management decisions for bradycardia in the setting of AMI are determined by location of infarction, timing of the dysrhythmia, rhythm assessment, and hemodynamic status of the patient. Atrial fibrillation is common in the setting of AMI, and caution is warranted in acute rate control for rapid ventricular rate given the possibility of compensation for decreased ventricular function. Regular wide complex tachycardia in the setting of AMI should be managed as ventricular tachycardia with electrocardioversion in the majority of cases. Management directed towards HF from left ventricular dysfunction in AMI consists of noninvasive positive pressure ventilation, nitroglycerin therapy, and early cardiac catheterization. Norepinephrine is the first line vasopressor for patients with cardiogenic shock and hypoperfusion on clinical examination. Early involvement of a multi-disciplinary team is recommended when caring for patients in cardiogenic shock. Conclusions: This review discusses considerations of ED management of dysrhythmias and HF associated with AMI.

Original languageEnglish (US)
JournalAmerican Journal of Emergency Medicine
DOIs
StatePublished - Jan 1 2019

Fingerprint

Emergency Medicine
Heart Failure
Myocardial Infarction
Hospital Emergency Service
Cardiogenic Shock
Ventricular Function
Positive-Pressure Respiration
Nitroglycerin
Left Ventricular Dysfunction
Bradycardia
Ventricular Tachycardia
Cardiac Catheterization
Tachycardia
Atrial Fibrillation
Infarction
Norepinephrine
Ischemia
Hemodynamics
Guidelines
Morbidity

Keywords

  • Acute myocardial infarction
  • Atrial fibrillation
  • Bradycardia
  • Cardiogenic shock
  • Dysrhythmia
  • Heart block
  • Heart failure
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Dysrhythmias and heart failure complicating acute myocardial infarction : An emergency medicine review. / Davis, William T.; Montrief, Tim; Koyfman, Alexander; Long, Brit.

In: American Journal of Emergency Medicine, 01.01.2019.

Research output: Contribution to journalReview article

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abstract = "Introduction: Patients with acute myocardial infarction (AMI) may suffer several complications after the acute event, including dysrhythmias and heart failure (HF). These complications place patients at risk for morbidity and mortality. Objective: This narrative review evaluates literature and guideline recommendations relevant to the acute emergency department (ED) management of AMI complicated by dysrhythmia or HF, with a focus on evidence-based considerations for ED interventions. Discussion: Limited evidence exists for ED management of dysrhythmias in AMI due to relatively low prevalence and frequent exclusion of patients with active cardiac ischemia from clinical studies. Management decisions for bradycardia in the setting of AMI are determined by location of infarction, timing of the dysrhythmia, rhythm assessment, and hemodynamic status of the patient. Atrial fibrillation is common in the setting of AMI, and caution is warranted in acute rate control for rapid ventricular rate given the possibility of compensation for decreased ventricular function. Regular wide complex tachycardia in the setting of AMI should be managed as ventricular tachycardia with electrocardioversion in the majority of cases. Management directed towards HF from left ventricular dysfunction in AMI consists of noninvasive positive pressure ventilation, nitroglycerin therapy, and early cardiac catheterization. Norepinephrine is the first line vasopressor for patients with cardiogenic shock and hypoperfusion on clinical examination. Early involvement of a multi-disciplinary team is recommended when caring for patients in cardiogenic shock. Conclusions: This review discusses considerations of ED management of dysrhythmias and HF associated with AMI.",
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