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 MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. 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 Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth