Attention PCP's: The Prior Inpatient Post-MI Complications Are Now More Likely to Present to Your Outpatient Clinic

Abstract

Cardiovascular disease is one of the leading causes of hospitalization and death in the United States. Every 40 seconds an acute myocardial infarction occurs. Most of the mortality occurs before the patient can reach medical care. Those that do reach medical care have seen a dramatic improvement in survival. The American Heart Association 2019 heart disease and stroke statistics from 2006 to 2016 show that the death rate has decreased by 31.8%. This decrease in mortality is multifactorial starting with enhanced public awareness of the early signs of myocardial infarction with mobilization of first responders, rapid reperfusion therapy and improved medical care. These improvements have resulted in a decrease in the mechanical complications of left ventricular rupture, acquired ventricular septal defect and papillary muscle rupture. However, these have not been eliminated and due to the shorter hospital stay after an MI with their peak incidence occurring more than 3 days post infarction has resulted in a change in the presentation of these complications. It was not that long ago that the usual length of stay for what was called a transmural MI or Q –wave MI was 21 days and a sub-endocardial or non-Q wave 10 days. This duration of observation made the presentation of post myocardial mechanical complications an in-hospital diagnosis. However, now in the era of reperfusion for both STEMI and NSTEMI, it is uncommon to see a length of stay longer than 3 days. While this early discharge practice has been shown to be safe, it shifts the diagnosis and treatment of post MI complications to the outpatient clinic where the Primary Care Provider (PCP) may be the first to see the patient post discharge. This paper will review the three most common mechanical complications that occur post MI and provide keys to their diagnosis and triage.