Page 169 - Clinical Pearls in Cardiology

Ischemic Heart Disease 157

7. What is a ventricular pseudoaneurysm?
Ventricular pseudoaneurysm is a rare complication of
acute myocardial infarction (large infarctions involving
more than 20% of the free wall), which necessitates
emergency surgical intervention. In this condition, there
is incomplete rupture of the ventricular free wall. This
myocardial rupture is contained temporarily by a section
of the pericardium overlying the area of rupture. It is a
surgical emergency because such pseudoaneurysms
can become a complete free wall rupture at any time,
and produce serious circulatory collapse. Unlike a
pseudoaneurysm, true ventricular aneurysms rarely
rupture, and medical management is usually sufficient.
8. What are the indications for primary percutaneous
coronary intervention or PCI in patients with acute
myocardial infarction?
Primary percutaneous coronary intervention is strongly
preferred in acute myocardial infarction in the following
subset of patients:

Indications for primary PCI
• Those with cardiogenic shock
• Those with heart failure
• Those presenting late (symptoms of more than 12 hours
duration)
• Those with only ST segment depression (except in true
posterior MI)
• Those with contraindications to fibrinolytic therapy *
* Absolute contraindications to fibrinolytic therapy includes: (1) history of
intracranial hemorrhage (ICH) or significant closed head or facial trauma
within the past 3 months, (2) uncontrolled hypertension, and (3) ischemic
stroke within the past 3 months.