Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Postinfarct VSD + • Infarction of interventricular septum with subsequent VSD formation• Interval between myocardial infarction (MI) and septal rupture: 1-12 days• Histologic findings: Cardiac muscle degeneration and weakening• Classically, sudden shock or congestive heart failure develops in a patient after MI• Defect in anterior apical septum if left anterior descending coronary artery occlusion, posterior basilar septum if right coronary occlusion +++ LV Aneurysm + • Large MI progresses to thinned-out transmural scar, bulges paradoxically during systole• 90% of aneurysms involve anteroseptal LV, 10% posterior• 50% contain mural thrombus +++ Epidemiology +++ Postinfarct VSD + • < 1% of patients with acute MI• Poor prognosis-24% die on first day-65% by 2 weeks-81% by 2 mos +++ LV Aneurysm + • 2-4% of MI, incidence is decreasing with more aggressive management of MI +++ Symptoms and Signs +++ Postinfarct VSD + • Harsh holosystolic murmur along left sternal border• 67% have palpable thrill +++ LV Aneurysm + • Congestive heart failure, angina, embolization, ventricular dysrhythmias• Prominent apical pulse +++ Laboratory Findings + • ECG: Q wave MI with persistent ST segment elevation +++ Imaging Findings +++ Postinfarct VSD + • Echocardiography: Definitive diagnosis• Catheterization: Also definitive +++ LV Aneurysm + • Chest film: Localized LV bulge• Echocardiography and catheterization are definitive + • Echocardiography and catheterization +++ Rule Out + • Papillary muscle dysfunction• Rupture of papillary muscle with acute mitral insufficiency• Pericardial friction rub after MI (Dressler syndrome) + • Echocardiography: for definitive diagnosis• Catheterization allows assessment of coronary anatomy +++ Postinfarct VSD + • Preoperative intra-aortic balloon pump• Operation: Patch closure of VSD (using double patch) + coronary artery bypass performed early +++ LV Aneurysm + • Resect aneurysm (Dor procedure) + coronary revascularization +++ Surgery +++ Indications +++ Postinfarct VSD + • Indicated in nearly all cases +++ LV Aneurysm + • Good to moderate operative risk +++ Contraindications + • Postinfarct VSD: Advanced age with multiorgan failure +++ Complications +++ Postinfarct VSD + • 50-80% survive operation depending on degree of multiorgan failure +++ Prognosis +++ LV Aneurysm + • Improvement in congestive heart failure, angina in 70-85% of survivors• 70-80% of patients alive 5 years postoperatively, significantly more than those who ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.