Attention PCP's: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic

Maria Jose Zabala Ramirez; Robert Lichtenberg

doi:doi:10.11648/j.ajim.20200803.14

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Attention PCP's: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic

Maria Jose Zabala Ramirez, Robert Lichtenberg

Published in American Journal of Internal Medicine (Volume 8, Issue 3)

Received: 14 April 2020 Accepted: 29 April 2020 Published: 15 May 2020

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Abstract

Cardiovascular disease is one of the leading causes of hospitalization and death in the United States. Every 40 seconds an acute myocardial infarction occurs. Most of the mortality occurs before the patient can reach medical care. Those that do reach medical care have seen a dramatic improvement in survival. The American Heart Association 2019 heart disease and stroke statistics from 2006 to 2016 show that the death rate has decreased by 31.8%. This decrease in mortality is multifactorial starting with enhanced public awareness of the early signs of myocardial infarction with mobilization of first responders, rapid reperfusion therapy and improved medical care. These improvements have resulted in a decrease in the mechanical complications of left ventricular rupture, acquired ventricular septal defect and papillary muscle rupture. However, these have not been eliminated and due to the shorter hospital stay after an MI with their peak incidence occurring more than 3 days post infarction has resulted in a change in the presentation of these complications. It was not that long ago that the usual length of stay for what was called a transmural MI or Q –wave MI was 21 days and a sub-endocardial or non-Q wave 10 days. This duration of observation made the presentation of post myocardial mechanical complications an in-hospital diagnosis. However, now in the era of reperfusion for both STEMI and NSTEMI, it is uncommon to see a length of stay longer than 3 days. While this early discharge practice has been shown to be safe, it shifts the diagnosis and treatment of post MI complications to the outpatient clinic where the Primary Care Provider (PCP) may be the first to see the patient post discharge. This paper will review the three most common mechanical complications that occur post MI and provide keys to their diagnosis and triage.

Published in	American Journal of Internal Medicine (Volume 8, Issue 3)
DOI	10.11648/j.ajim.20200803.14
Page(s)	113-120
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Post MI Mechanical Complications, Acquired Ventricular Septal Defect, Papillary Muscle Rupture, Left Ventricular Free Wall Rupture

References

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[2]	Poulsen SH, Praestholm M, Munk K, Wierup P, Egeblad H, Nielsen-Kudsk JE. Ventricular septal rupture complicating acute myocardial infarction: clinical characteristics and contemporary outcome. Ann Thorac Surg 2008; 85 (5): 1591-6.
[3]	Menon V, Webb JG, Hillis LD, Sleeper LA, Abboud R, Dzavik V, et al. Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. J Am Coll Cardiol 2000; 36 (3 Suppl A): 1110-6.
[4]	Elbadawi A, Elgendy IY, Mahmoud K, Barakat AF, Mentias A, et al. Temporal Trends and Outcomes of Mechanical Complications in Patients with Acute Myocardial Infarction. J Am Coll Cardiol Intv 2019; 12: 1825-1836.
[5]	Herrick JB, Nuzum FR. Angina pectoris: Clinical experience with two hundred cases. J Am Med Assoc. 1918; 70 (2): 67-70.
[6]	Levine SA, Lown B. “Armchair” treatment of acute coronary thrombosis. J Am Med Assoc. 1952; 148 (16): 1365-1369.
[7]	Vavalle JP, Lopes RD, Chen AY, et al. Hospital length of stay in patients with non-st-segment elevation myocardial infarction. Am J Med. 2012; 125 (11): 1085-1094.
[8]	Myocardial Infarction: Practice Essentials, Background, Definitions. https://emedicine.medscape.com/article/155919-overview#a6. Accessed March 26, 2020
[9]	Acute myocardial infarction: Mechanical complications - UpToDate. https://www.uptodate.com/contents/acute-myocardial-infarction-mechanical-complications?source=history_widget. Accessed March 26, 2020.
[10]	Montrief T, Davis WT, Koyfman A, Long B. Mechanical, inflammatory, and embolic complications of myocardial infarction: An emergency medicine review. Am J Emerg Med. 2019; 37 (6): 1175-1183. doi: 10.1016/j.ajem.2019.04.003
[11]	O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. J Am Coll Cardiol 2013; 61 (4): e78-e140.
[12]	Laskey WK, Beach D. Frequency and Clinical Significance of Ischemic Preconditioning During Percutaneous Coroanry Intervention. J Am Coll Cardiol 2003; 42 (6): 998-1003.
[13]	Kloner RA, Shook T, Przyklenk K, et al. Previous angina alters in-hospital outcome in TIMI-4; a clinical correlate to preconditioning. Circulation 1995; 91: 37-45.
[14]	Oliva PB, Hammill SC, Edwards WD. Cardiac Rupture, a Clinically Predictable Complication of Acute Myocardial Infarction: Report of 70 Cases with Clinicopathologic Correlations. J Am Coll Cardiol 1993; 22: 720-726)
[15]	Montoya A, McKeever L, Scanlon P, Sullivan HJ, Gunnar RM, Pifarre R. Early repair of ventricular septal rupture after infarction. Am J of Cardiology 1980; 45 (2): 345-348.
[16]	Aronson D, Goldsher N, Zukermann R, Kapeliovich M, Lessick J, et al. Ischemic mitral regurgitation and risk of heart failure after myocardial infarction. Arch Intern Med 2006; 166 (21): 232-8.
[17]	Barbour DJ, Roberts WC. Rupture of a left ventricular papillary muscle during acute myocardial infarction: Analysis of 22 necropsy patients. J Am Coll Cardiol 1986; 8 (3): 558-565.

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APA Style

Maria Jose Zabala Ramirez, Robert Lichtenberg. (2020). Attention PCP's: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic. American Journal of Internal Medicine, 8(3), 113-120. https://doi.org/10.11648/j.ajim.20200803.14

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ACS Style

Maria Jose Zabala Ramirez; Robert Lichtenberg. Attention PCP's: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic. Am. J. Intern. Med. 2020, 8(3), 113-120. doi: 10.11648/j.ajim.20200803.14

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AMA Style

Maria Jose Zabala Ramirez, Robert Lichtenberg. Attention PCP's: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic. Am J Intern Med. 2020;8(3):113-120. doi: 10.11648/j.ajim.20200803.14

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@article{10.11648/j.ajim.20200803.14,
  author = {Maria Jose Zabala Ramirez and Robert Lichtenberg},
  title = {Attention PCP's: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic},
  journal = {American Journal of Internal Medicine},
  volume = {8},
  number = {3},
  pages = {113-120},
  doi = {10.11648/j.ajim.20200803.14},
  url = {https://doi.org/10.11648/j.ajim.20200803.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20200803.14},
  abstract = {Cardiovascular disease is one of the leading causes of hospitalization and death in the United States. Every 40 seconds an acute myocardial infarction occurs. Most of the mortality occurs before the patient can reach medical care. Those that do reach medical care have seen a dramatic improvement in survival. The American Heart Association 2019 heart disease and stroke statistics from 2006 to 2016 show that the death rate has decreased by 31.8%. This decrease in mortality is multifactorial starting with enhanced public awareness of the early signs of myocardial infarction with mobilization of first responders, rapid reperfusion therapy and improved medical care. These improvements have resulted in a decrease in the mechanical complications of left ventricular rupture, acquired ventricular septal defect and papillary muscle rupture. However, these have not been eliminated and due to the shorter hospital stay after an MI with their peak incidence occurring more than 3 days post infarction has resulted in a change in the presentation of these complications. It was not that long ago that the usual length of stay for what was called a transmural MI or Q –wave MI was 21 days and a sub-endocardial or non-Q wave 10 days. This duration of observation made the presentation of post myocardial mechanical complications an in-hospital diagnosis. However, now in the era of reperfusion for both STEMI and NSTEMI, it is uncommon to see a length of stay longer than 3 days. While this early discharge practice has been shown to be safe, it shifts the diagnosis and treatment of post MI complications to the outpatient clinic where the Primary Care Provider (PCP) may be the first to see the patient post discharge. This paper will review the three most common mechanical complications that occur post MI and provide keys to their diagnosis and triage.},
 year = {2020}
}

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TY - JOUR
T1 - Attention PCP's: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic
AU - Maria Jose Zabala Ramirez
AU - Robert Lichtenberg
Y1 - 2020/05/15
PY - 2020
N1 - https://doi.org/10.11648/j.ajim.20200803.14
DO - 10.11648/j.ajim.20200803.14
T2 - American Journal of Internal Medicine
JF - American Journal of Internal Medicine
JO - American Journal of Internal Medicine
SP - 113
EP - 120
PB - Science Publishing Group
SN - 2330-4324
UR - https://doi.org/10.11648/j.ajim.20200803.14
AB - Cardiovascular disease is one of the leading causes of hospitalization and death in the United States. Every 40 seconds an acute myocardial infarction occurs. Most of the mortality occurs before the patient can reach medical care. Those that do reach medical care have seen a dramatic improvement in survival. The American Heart Association 2019 heart disease and stroke statistics from 2006 to 2016 show that the death rate has decreased by 31.8%. This decrease in mortality is multifactorial starting with enhanced public awareness of the early signs of myocardial infarction with mobilization of first responders, rapid reperfusion therapy and improved medical care. These improvements have resulted in a decrease in the mechanical complications of left ventricular rupture, acquired ventricular septal defect and papillary muscle rupture. However, these have not been eliminated and due to the shorter hospital stay after an MI with their peak incidence occurring more than 3 days post infarction has resulted in a change in the presentation of these complications. It was not that long ago that the usual length of stay for what was called a transmural MI or Q –wave MI was 21 days and a sub-endocardial or non-Q wave 10 days. This duration of observation made the presentation of post myocardial mechanical complications an in-hospital diagnosis. However, now in the era of reperfusion for both STEMI and NSTEMI, it is uncommon to see a length of stay longer than 3 days. While this early discharge practice has been shown to be safe, it shifts the diagnosis and treatment of post MI complications to the outpatient clinic where the Primary Care Provider (PCP) may be the first to see the patient post discharge. This paper will review the three most common mechanical complications that occur post MI and provide keys to their diagnosis and triage.
VL - 8
IS - 3
ER -

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Author Information

Maria Jose Zabala Ramirez

Loyola – MacNeal Internal Medicine Residency, MacNeal Hospital, Berwyn, USA
Robert Lichtenberg

Loyola – MacNeal Internal Medicine Residency, MacNeal Hospital, Berwyn, USA

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Plain Text BibTeX RIS

APA Style

Maria Jose Zabala Ramirez, Robert Lichtenberg. (2020). Attention PCP's: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic. American Journal of Internal Medicine, 8(3), 113-120. https://doi.org/10.11648/j.ajim.20200803.14

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ACS Style

Maria Jose Zabala Ramirez; Robert Lichtenberg. Attention PCP's: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic. Am. J. Intern. Med. 2020, 8(3), 113-120. doi: 10.11648/j.ajim.20200803.14

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AMA Style

Maria Jose Zabala Ramirez, Robert Lichtenberg. Attention PCP's: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic. Am J Intern Med. 2020;8(3):113-120. doi: 10.11648/j.ajim.20200803.14

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@article{10.11648/j.ajim.20200803.14,
  author = {Maria Jose Zabala Ramirez and Robert Lichtenberg},
  title = {Attention PCP's: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic},
  journal = {American Journal of Internal Medicine},
  volume = {8},
  number = {3},
  pages = {113-120},
  doi = {10.11648/j.ajim.20200803.14},
  url = {https://doi.org/10.11648/j.ajim.20200803.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20200803.14},
  abstract = {Cardiovascular disease is one of the leading causes of hospitalization and death in the United States. Every 40 seconds an acute myocardial infarction occurs. Most of the mortality occurs before the patient can reach medical care. Those that do reach medical care have seen a dramatic improvement in survival. The American Heart Association 2019 heart disease and stroke statistics from 2006 to 2016 show that the death rate has decreased by 31.8%. This decrease in mortality is multifactorial starting with enhanced public awareness of the early signs of myocardial infarction with mobilization of first responders, rapid reperfusion therapy and improved medical care. These improvements have resulted in a decrease in the mechanical complications of left ventricular rupture, acquired ventricular septal defect and papillary muscle rupture. However, these have not been eliminated and due to the shorter hospital stay after an MI with their peak incidence occurring more than 3 days post infarction has resulted in a change in the presentation of these complications. It was not that long ago that the usual length of stay for what was called a transmural MI or Q –wave MI was 21 days and a sub-endocardial or non-Q wave 10 days. This duration of observation made the presentation of post myocardial mechanical complications an in-hospital diagnosis. However, now in the era of reperfusion for both STEMI and NSTEMI, it is uncommon to see a length of stay longer than 3 days. While this early discharge practice has been shown to be safe, it shifts the diagnosis and treatment of post MI complications to the outpatient clinic where the Primary Care Provider (PCP) may be the first to see the patient post discharge. This paper will review the three most common mechanical complications that occur post MI and provide keys to their diagnosis and triage.},
 year = {2020}
}

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