Myocardial infarction complicated by ventricular septal perforation
Introduction
Introduction of myocardial infarction complicated with ventricular septal perforation Ventricular septal perforation is one of the serious complications after acute myocardial infarction. In the heart piercing caused by acute myocardial infarction, it is located in the ventricular septum about 10%. In the pathological anatomy of patients with acute myocardial infarction, the incidence of ventricular septal perforation was 1.3 to 2.0%. In 1847, Latham reported the first patient, and in 1957, Cooley performed surgical suture. basic knowledge The proportion of illness: 0.04% Susceptible people: no specific population Mode of infection: non-infectious Complications: mitral regurgitation pulmonary edema ascites hemoptysis
Cause
Myocardial infarction complicated by ventricular septal perforation
Cause:
This disease is one of the serious complications after acute myocardial infarction, so acute myocardial infarction is the only cause of this disease.
Pathological change
The extent of myocardial transmural infarction is generally more extensive in patients with ventricular septal perforation. The time of ventricular septal perforation is generally about 2 weeks after myocardial infarction, the shortest is 24 hours, and the longest is 23 days. The most common site of ventricular septal perforation (60%) is in front of the ventricular septum, close to the apical region, due to stenosis or obstruction of the anterior descending coronary artery leading to full-thickness infarction of the anterior wall. The piercing site is about 20% of the posterior ventricular septum, and the inferior myocardial infarction is caused by lesions in the posterior coronary artery. When there are obstructive lesions in the anterior descending and posterior descending branches, the ventricular septum can be pierced in multiple places, occurring within a few days. Cases that are worn behind the ventricular septum are often accompanied by papillary muscle infarction or dysfunction, resulting in mitral regurgitation. The small diameter of the ventricular septum is only a few millimeters, and the larger one can reach 3 to 4 cm. The edge of the worn area is not neatly organized. The larger the diameter of the broken hole, the more the left-to-right partial flow, and the hemodynamic effect is more serious.
Prevention
Myocardial infarction complicated with ventricular septal perforation prevention
This disease is the most common complication of acute myocardial infarction, so active treatment of primary disease is an effective measure to prevent this disease. Vitamin C and trace elements are added. To strengthen the elasticity, toughness and prevent bleeding of blood vessels, trace element iodine can reduce the deposition of cholesterol and calcium salts in the blood vessel wall, and hinder the formation of atherosclerotic lesions (the seafood contains iodine); magnesium can improve myocardial excitability, Helps to inhibit heart rhythm disorder (magnesium is more abundant in green leafy vegetables).
Complication
Myocardial infarction complicated with ventricular septal rupture complications Complications mitral regurgitation pulmonary edema ascites hemoptysis
Can be complicated by inferior myocardial infarction, mitral regurgitation and so on.
1. Inferior wall infarction
The blood vessels in the inferior wall of the heart are embolized, resulting in myocardial necrosis and ischemia.
2, mitral regurgitation
The mitral valve consists of four components: the leaflets, the annulus, the chordae and the papillary muscles, any of which can cause structural abnormalities or dysfunction, which can lead to mitral regurgitation, usually from primary rheumatic carditis to Symptoms of apparent mitral regurgitation can be as long as 20 years; in the event of heart failure, rapid progression, mild mitral regurgitation may have no obvious symptoms or only mild discomfort, severe mitral regurgitation Common symptoms are: labor dyspnea, fatigue, sitting breathing, etc., activity endurance is significantly reduced, hemoptysis and embolism are less common, late hemorrhage can appear hepatic congestion, tenderness, ankle edema, pleural effusion Or ascites, acute acute heart failure or pulmonary edema can occur quickly.
Symptom
Myocardial infarction complicated with ventricular septal perforation symptoms Common symptoms pale pale heart murmur chest pain limbs wet cold oliguria dyspnea tremor heart failure heart structure abnormal shock
The main clinical manifestation of ventricular septal rupture is a rough, full systolic heart murmur from day to 2 weeks after myocardial infarction. The murmur is usually located below the left sternal border and can be transmitted to the ankle. About half of the patients are accompanied by tremor, and some patients Before starting to present murmurs, I felt severe chest pain. After ventricular septal rupture, myocardial level left to right blood shunts were sharply produced. The perforation diameter was large. The patients with multiple flow rates could quickly present acute heart failure. The patient was pale, the limbs were cold, and the pulse was weak. Lower blood pressure, decreased urine output, and difficulty breathing. About 50% of patients may die of heart failure and shock in the short term due to serious illness.
Examine
Examination of myocardial infarction complicated with ventricular septal perforation
Chest X-ray examination showed an increase in pulmonary vascular shadows.
An electrocardiogram can show the location of the myocardial infarction.
Right heart catheterization can be found at the ventricular level, blood oxygen levels are increased, pulmonary circulation blood flow often exceeds the systemic blood flow more than 1 times, pulmonary artery pressure and pulmonary micro-adhesion pressure increased.
Selective left ventricular angiography can help to determine the location and number of ventricular septal perforation, to understand the left ventricular function and to determine the presence or absence of mitral regurgitation and its severity, but not for severe cases.
Selective coronary angiography can help to understand the number and extent of coronary artery disease, and can provide important information for determining whether coronary artery bypass grafting is needed.
Echocardiography and ultrasound pulse Doppler examination as well as nuclear myocardial scanning also help to determine the location and extent of myocardial infarction.
Diagnosis
Diagnosis and diagnosis of myocardial infarction complicated with ventricular septal puncture
Interventricular septal puncture needs to be differentiated from papillary muscle infarction and mitral regurgitation caused by rupture. The history, clinical symptoms and signs are similar, but acute mitral regurgitation often causes clinical symptoms of pulmonary edema; Located in the apical region to the ankle, rarely accompanied by tremor; ECG examination often shows signs of posterolateral myocardial ischemia; right heart catheterization at the ventricular level without left to right shunt; pulmonary micro-embedded pressure showing increased left atrial pressure; pressure curve Presents a high-point V wave.
