Which rare mechanical complication of myocardial infarction can lead to tamponade?

Prepare for the Emergency Nursing Orientation 3.0 Cardiovascular Emergencies Test. Use interactive flashcards and detailed explanations with multiple choice questions. Enhance your understanding of cardiovascular emergencies and succeed on your exam!

Multiple Choice

Which rare mechanical complication of myocardial infarction can lead to tamponade?

A rupture of the free wall of the left ventricle after a myocardial infarction can bleed into the pericardial space, causing cardiac tamponade. When the ventricle wall tears, blood rapidly accumulates in the pericardial sac, raising intrapericardial pressure and restricting diastolic filling. That drop in preload leads to a rapid fall in cardiac output, producing hypotension and shock. Clinically, this can present with sudden hemodynamic collapse, tachycardia, elevated jugular venous pressure, and often muffled heart sounds; pulsus paradoxus may be present as well. This is a rare but catastrophic mechanical complication and requires emergent pericardiocentesis and surgical repair. The other complications involve different problems. Papillary muscle rupture causes acute mitral regurgitation with a new systolic murmur and pulmonary edema rather than tamponade. Ventricular septal rupture creates a left-to-right shunt producing new heart failure symptoms and a harsh holosystolic murmur, not tamponade. Left ventricular hypertrophy is a chronic structural adaptation and does not acutely cause tamponade.

A rupture of the free wall of the left ventricle after a myocardial infarction can bleed into the pericardial space, causing cardiac tamponade. When the ventricle wall tears, blood rapidly accumulates in the pericardial sac, raising intrapericardial pressure and restricting diastolic filling. That drop in preload leads to a rapid fall in cardiac output, producing hypotension and shock. Clinically, this can present with sudden hemodynamic collapse, tachycardia, elevated jugular venous pressure, and often muffled heart sounds; pulsus paradoxus may be present as well. This is a rare but catastrophic mechanical complication and requires emergent pericardiocentesis and surgical repair.

The other complications involve different problems. Papillary muscle rupture causes acute mitral regurgitation with a new systolic murmur and pulmonary edema rather than tamponade. Ventricular septal rupture creates a left-to-right shunt producing new heart failure symptoms and a harsh holosystolic murmur, not tamponade. Left ventricular hypertrophy is a chronic structural adaptation and does not acutely cause tamponade.

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