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Dysrhythmias and heart failure complicating acute myocardial infarction: An emergency medicine review

Published:April 27, 2019DOI:https://doi.org/10.1016/j.ajem.2019.04.047

      Abstract

      Introduction

      Patients with acute myocardial infarction (AMI) may suffer several complications after the acute event, including dysrhythmias and heart failure (HF). These complications place patients at risk for morbidity and mortality.

      Objective

      This narrative review evaluates literature and guideline recommendations relevant to the acute emergency department (ED) management of AMI complicated by dysrhythmia or HF, with a focus on evidence-based considerations for ED interventions.

      Discussion

      Limited evidence exists for ED management of dysrhythmias in AMI due to relatively low prevalence and frequent exclusion of patients with active cardiac ischemia from clinical studies. Management decisions for bradycardia in the setting of AMI are determined by location of infarction, timing of the dysrhythmia, rhythm assessment, and hemodynamic status of the patient. Atrial fibrillation is common in the setting of AMI, and caution is warranted in acute rate control for rapid ventricular rate given the possibility of compensation for decreased ventricular function. Regular wide complex tachycardia in the setting of AMI should be managed as ventricular tachycardia with electrocardioversion in the majority of cases. Management directed towards HF from left ventricular dysfunction in AMI consists of noninvasive positive pressure ventilation, nitroglycerin therapy, and early cardiac catheterization. Norepinephrine is the first line vasopressor for patients with cardiogenic shock and hypoperfusion on clinical examination. Early involvement of a multi-disciplinary team is recommended when caring for patients in cardiogenic shock.

      Conclusions

      This review discusses considerations of ED management of dysrhythmias and HF associated with AMI.

      Keywords

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      References

        • American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Suspected Non–ST-Elevation Acute Coronary Syndromes
        • MD Tomaszewski C.A.
        • Nestler D.
        • et al.
        Clinical policy: critical issues in the evaluation and management of emergency department patients with suspected non-ST-elevation acute coronary syndromes.
        Ann Emerg Med. 2018; 72: e65-e106
        • Frampton J.
        • Devries J.T.
        • Welch T.D.
        • Gersh B.J.
        Modern management of ST-segment elevation myocardial infarction.
        Curr Probl Cardiol. 2018; (pii: S0146-2806(18)30130-0 [Epub ahead of print])https://doi.org/10.1016/j.cpcardiol.2018.08.005
        • Awad H.H.
        • Anderson F.A.
        • Gore J.M.
        • Goodman S.G.
        • Goldberg R.J.
        Cardiogenic shock complicating acute coronary syndromes: insights from the Global Registry of Acute Coronary Events.
        Am Heart J. 2012; 163: 963-971
        • Goldberg R.J.
        • Spencer F.A.
        • Gore J.M.
        • Lessard D.
        • Yarzebski J.
        Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective.
        Circulation. 2009; 119: 1211-1219
        • Ibanez B.
        • James S.
        • Agewall S.
        • et al.
        2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).
        Eur Heart J. 2018; 39: 119-177
        • Zimetbaum P.J.
        • Josephson M.E.
        Use of the electrocardiogram in acute myocardial infarction.
        N Engl J Med. 2003; 348: 933-940
        • Newby K.H.
        • Pisano´ E.
        • Krucoff M.W.
        • Green C.
        • Natale A.
        Incidence and clinical relevance of the occurrence of bundle-branch block in patients treated with thrombolytic therapy.
        Circulation. 1996; 94: 2424-2428
        • Morris F.
        • Brady W.J.
        ABC of clinical electrocardiography: acute myocardial infarction-part I.
        BMJ. 2002; 324: 831-834
        • Brady W.J.
        • Harrigan R.A.
        Diagnosis and management of bradycardia and atrioventricular block associated with acute coronary ischemia.
        Emerg Med Clin North Am. 2001; 19: 371-384
        • Rotman M.
        • Gs Wagner
        • Wallace A.G.
        Bradyarrhythmias in acute myocardial infarction.
        Circulation. 1972; 45: 703-722
        • Sodeck G.H.
        • Domanovits H.
        • Meron G.
        • et al.
        Compromising bradycardia: management in the emergency department.
        Resuscitation. 2007; 73: 96-102
        • Feigl D.
        • Ashkenazy J.
        • Kishon Y.
        Early and late atrioventricular block in acute inferior myocardial infarction.
        J Am Coll Cardiol. 1984; 4: 35-38
        • Wei J.Y.
        • Markis J.E.
        • Malagold M.
        • Braunwald E.
        Cardiovascular reflexes stimulated by reperfusion of ischemic myocardium in acute myocardial infarction.
        Circulation. 1983; 67: 796-801
        • Swart G.
        • Brady W.J.
        • DeBehnke D.J.
        • MA O.J.
        • Aufderheide T.P.
        Acute myocardial infarction complicated by hemodynamically unstable bradyarrhythmia: prehospital and ED treatment with atropine.
        Am J Emerg Med. 1999; 17: 647-652
        • Brady William J.
        • Laughrey Thomas S.
        • Ghaemmaghami Chris A.
        Cardiac rhythm disturbances.
        in: Tintinalli's emergency medicine: a comprehensive study guide. 2017: 8e
        • Rathore S.S.
        • Gersh B.J.
        • Berger P.B.
        • et al.
        Acute myocardial infarction complicated by heart block in the elderly: prevalence and outcomes.
        Am Heart J. 2001; 141: 47-54
        • Auffret V.
        • Loirat A.
        • Leurent G.
        • et al.
        High-degree atrioventricular block complicating ST segment elevation myocardial infarction in the contemporary era.
        Heart. 2016; 102: 40-49
        • Singh S.M.
        • FitzGerald G.
        • Yan A.T.
        • et al.
        High-grade atrioventricular block in acute coronary syndromes: insights from the Global Registry of Acute Coronary Events.
        Eur Heart J. 2015; 36: 976-983
        • Gang U.J.O.
        • Hvelplund A.
        • Pedersen S.
        • et al.
        High-degree atrioventricular block complicating ST-segment elevation myocardial infarction in the era of primary percutaneous coronary intervention.
        Europace. 2012; 14: 1639-1645
        • Lavie C.J.
        • Gersh B.J.
        Mechanical and electrical complications of acute myocardial infarction.
        Mayo Clin Proc. 1990; 65: 709-730
        • Hackel D.B.
        • Sevilla M.D.
        • Mikat E.M.
        • Reimer K.A.
        • Ideker R.E.
        • Turi Z.G.
        Comparison of patients with acute anterior or posterior myocardial infarcts with and without complete heart block.
        Am J Cardiovasc Pathol. 1988; 2: 105-126
        • Kusumoto F.M.
        • Schoenfeld M.H.
        • Barrett C.
        • et al.
        ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay.
        J Am Coll Cardiol. 2018; (November 2018): 25701
        • Brady W.J.
        • Swart G.
        • DeBehnke D.J.
        • Ma O.J.
        • Aufderheide T.P.
        The efficacy of atropine in the treatment of hemodynamically unstable bradycardia and atrioventricular block: prehospital and emergency department considerations.
        Resuscitation. 1999; 41: 47-55
        • Scheinman M.M.
        • Thorburn D.
        • Abbott J.A.
        Use of atropine in patients with acute myocardial infarction and sinus bradycardia.
        Circulation. 1975; 52: 627-633
        • Link M.S.
        • Berkow L.C.
        • Kudenchuk P.J.
        • et al.
        Part 7: adult advanced cardiovascular life support.
        Circulation. 2015; 132: S444-S464
      1. Moitra VK, Gabrielli A, Maccioli GA, O'Connor MF. Anesthesia advanced circulatory life support. Can J Anesth Can d'anesthésie. 2012;59(6):586–603.

        • Bektas F.
        • Soyuncu S.
        The efficacy of transcutaneous cardiac pacing in ED.
        Am J Emerg Med. 2016; 34: 2090-2093
        • Barthell E.
        • Troiano P.
        • Olson D.
        • Stueven H.A.
        • Hendley G.
        Prehospital external cardiac pacing: a prospective, controlled clinical trial.
        Ann Emerg Med. 1988; 17: 1221-1226
        • Hedges J.R.
        • Feero S.
        • Shultz B.
        • Easter R.
        • Syverud S.A.
        • Dalsey W.C.
        Prehospital transcutaneous cardiac pacing for symptomatic bradycardia.
        Pacing Clin Electrophysiol. 1991; 14: 1473-1478
        • Antman E.M.
        • Anbe D.T.
        • Armstrong P.W.
        • et al.
        ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary.
        Circulation. 2004; 110: 588-636
        • Schmitt J.
        • Duray G.
        • Gersh B.J.
        • Hohnloser S.H.
        Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications.
        Eur Heart J. 2009; 30: 1038-1045
        • Batra G.
        • Svennblad B.
        • Held C.
        • et al.
        All types of atrial fibrillation in the setting of myocardial infarction are associated with impaired outcome.
        Heart. 2016; 102: 926-933
        • Roffi M.
        • Patrono C.
        • Collet J.-P.
        • et al.
        2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.
        Eur Heart J. 2016; 37: 267-315
        • Long B.
        • Robertson J.
        • Koyfman A.
        • Maliel K.
        • Warix J.R.
        Emergency medicine considerations in atrial fibrillation.
        Am J Emerg Med. 2018; 36: 1070-1078
        • Scheuermeyer F.X.
        • Pourvali R.
        • Rowe B.H.
        • et al.
        Emergency department patients with atrial fibrillation or flutter and an acute underlying medical illness may not benefit from attempts to control rate or rhythm.
        Ann Emerg Med. 2015; 65: 511-522.e2
        • January C.T.
        • Wann L.S.
        • Calkins H.
        • Chen L.Y.
        • Cigarroa J.E.
        • Cleveland Jr, J.C.
        • et al.
        2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
        J Am Coll Cardiol. 2019; (pii: S0735-1097(19)30209-8 [Epub ahead of print])https://doi.org/10.1016/j.jacc.2019.01.011
        • Atzema C.L.
        • Barrett T.W.
        Managing atrial fibrillation.
        Ann Emerg Med. 2015; 65: 532-539
        • Clemo H.F.
        • Wood M.A.
        • Gilligan D.M.
        • Ellenbogen K.A.
        Intravenous amiodarone for acute heart rate control in the critically ill patient with atrial tachyarrhythmias.
        Am J Cardiol. 1998; 81: 594-598
        • Fromm C.
        • Suau S.J.
        • Cohen V.
        • et al.
        Diltiazem vs. metoprolol in the management of atrial fibrillation or flutter with rapid ventricular rate in the emergency department.
        J Emerg Med. 2015; 49: 175-182
        • Hirschy R.
        • Ackerbauer K.A.
        • Peksa G.D.
        • O'Donnell E.P.
        • DeMott J.M.
        Metoprolol vs. diltiazem in the acute management of atrial fibrillation in patients with heart failure with reduced ejection fraction.
        Am J Emerg Med. 2019; 37: 80-84
        • Scheuermeyer F.X.
        • Grafstein E.
        • Stenstrom R.
        • et al.
        Safety and efficiency of calcium channel blockers versus beta-blockers for rate control in patients with atrial fibrillation and no acute underlying medical illness.
        Acad Emerg Med. 2013; 20 (Smith SW, ed.): 222-230
        • Perron A.D.
        • Sweeney T.
        Arrhythmic complications of acute coronary syndromes.
        Emerg Med Clin North Am. 2005; 23: 1065-1082
        • Rothfeld E.L.
        • Zucker I.R.
        • Parsonnet V.
        • Alinsonorin C.A.
        Idioventricular rhythm in acute myocardial infarction.
        Circulation. 1968; 37: 203-209
        • Long B.
        • Koyfman A.
        Best clinical practice: emergency medicine management of stable monomorphic ventricular tachycardia.
        J Emerg Med. 2017; 52: 484-492
        • Benito B.
        • Josephson M.E.
        Ventricular tachycardia in coronary artery disease.
        Rev Española Cardiol (English Ed. 2012; 65: 939-955
        • Carmeliet E.E.
        Cardiac ionic currents and acute ischemia: from channels to arrhythmias.
        Physiol Rev. 1999; 79: 917
        • Martín-Sánchez F.J.
        • Bueno H.
        Are available electrocardiographic methods accurate enough to diagnose ventricular tachycardia in the emergency department? Cone DC, ed.
        Acad Emerg Med. 2014; 21: 217-219https://doi.org/10.1111/acem.12318
        • Vereckei A.
        Current algorithms for the diagnosis of wide QRS complex tachycardias.
        Curr Cardiol Rev. 2014; 10: 262-276
        • Neumar R.W.
        • Otto C.W.
        • Link M.S.
        • et al.
        Part 8: adult advanced cardiovascular life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2010; 122: S729-S767
        • Al-Khatib S.M.
        • Stevenson W.G.
        • Ackerman M.J.
        • et al.
        2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary.
        Circulation. 2018; 138
        • Somberg J.C.
        • Timar S.
        • Bailin S.J.
        • et al.
        Lack of a hypotensive effect with rapid administration of a new aqueous formulation of intravenous amiodarone.
        Am J Cardiol. 2004; 93: 576-581
        • Ortiz M.
        • Martín A.
        • Arribas F.
        • et al.
        Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study.
        Eur Heart J. 2016; 38ehw230
        • Gorgels A.P.
        • van den Dool A.
        • Hofs A.
        • et al.
        Comparison of procainamide and lidocaine in terminating sustained monomorphic ventricular tachycardia.
        Am J Cardiol. 1996; 78: 43-46
        • Marill K.A.
        • deSouza I.S.
        • Nishijima D.K.
        • et al.
        Amiodarone or procainamide for the termination of sustained stable ventricular tachycardia: an historical multicenter comparison.
        Acad Emerg Med. 2010; 17: 297-306
        • Fonarow G.C.
        • Abraham W.T.
        • Albert N.M.
        • et al.
        Factors identified as precipitating hospital admissions for heart failure and clinical outcomes<subtitle>findings from OPTIMIZE-HF</subtitle&gt.
        Arch Intern Med. 2008; 168: 847
        • Khot U.N.
        • Jia G.
        • Moliterno D.J.
        • et al.
        Prognostic importance of physical examination for heart failure in non–ST-elevation acute coronary syndromes.
        JAMA. 2003; 290: 2174
        • Spencer F.A.
        • Meyer T.E.
        • Gore J.M.
        • Goldberg R.J.
        Heterogeneity in the management and outcomes of patients with acute myocardial infarction complicated by heart failure.
        Circulation. 2002; 105: 2605-2610
        • Flaherty J.D.
        • Bax J.J.
        • De Luca L.
        • et al.
        Acute heart failure syndromes in patients with coronary artery disease: early assessment and treatment.
        J Am Coll Cardiol. 2009; 53: 254-263
        • Ponikowski P.
        • Voors A.A.
        • Anker S.D.
        • et al.
        2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.
        Eur Heart J. 2016; 37: 2129-2200
        • Cotter G.
        • Metzkor E.
        • Kaluski E.
        • et al.
        Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema.
        Lancet. 1998; 351: 389-393
        • Matsue Y.
        • Damman K.
        • Voors A.A.
        • et al.
        Time-to-furosemide treatment and mortality in patients hospitalized with acute heart failure.
        J Am Coll Cardiol. 2017; 69: 3042-3051
        • Long B.
        • Koyfman A.
        • Chin E.J.
        Misconceptions in acute heart failure diagnosis and management in the emergency department.
        Am J Emerg Med. 2018; 36: 1666-1673
        • Levy B.
        • Bastien O.
        • Bendjelid K.
        • et al.
        Experts' recommendations for the management of adult patients with cardiogenic shock.
        Ann Intensive Care. 2015; 5: 17
        • Aissaoui N.
        • Puymirat E.
        • Tabone X.
        • et al.
        Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: a report from the USIK 1995, USIC 2000, and FAST-MI French Nationwide Registries.
        Eur Heart J. 2012; 33: 2535-2543
        • Hochman J.S.
        • Sleeper L.A.
        • Webb J.G.
        • et al.
        Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction.
        JAMA. 2006; 295: 2511
        • Goldberg R.J.
        • Samad N.A.
        • Yarzebski J.
        • Gurwitz J.
        • Bigelow C.
        • Gore J.M.
        Temporal trends in cardiogenic shock complicating acute myocardial infarction.
        N Engl J Med. 1999; 340: 1162-1168
        • Hochman J.S.
        • Buller C.E.
        • Sleeper L.A.
        • et al.
        Cardiogenic shock complicating acute myocardial infarction—etiologies, management and outcome: a report from the SHOCK Trial Registry.
        J Am Coll Cardiol. 2000; 36: 1063-1070
        • Overgaard C.B.
        • Džavík V.
        Inotropes and vasopressors.
        Circulation. 2008; 118: 1047-1056
        • Perez P.
        • Kimmoun A.
        • Blime V.
        • Levy B.
        Increasing mean arterial pressure in cardiogenic shock secondary to myocardial infarction: effects on hemodynamics and tissue oxygenation.
        Shock. 2014; 41: 269-274https://doi.org/10.1097/SHK.0000000000000099
        • Hajjar L.A.
        • Teboul J.-L.
        Mechanical circulatory support devices for cardiogenic shock: state of the art.
        Crit Care. 2019; 23: 76
        • De Backer D.
        • Biston P.
        • Devriendt J.
        • et al.
        Comparison of dopamine and norepinephrine in the treatment of shock.
        N Engl J Med. 2010; 362: 779-789
        • Levy B.
        • Perez P.
        • Perny J.
        • Thivilier C.
        • Gerard A.
        Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock. A prospective, randomized pilot study*.
        Crit Care Med. 2011; 39: 450-455
        • Tarvasmäki T.
        • Lassus J.
        • Varpula M.
        • et al.
        Current real-life use of vasopressors and inotropes in cardiogenic shock - adrenaline use is associated with excess organ injury and mortality.
        Crit Care. 2016; 20: 208
        • Burger A.J.
        • Horton D.P.
        • LeJemtel T.
        • et al.
        Effect of nesiritide (B-type natriuretic peptide) and dobutamine on ventricular arrhythmias in the treatment of patients with acutely decompensated congestive heart failure: the PRECEDENT study.
        Am Heart J. 2002; 144: 1102-1108
        • Reynolds H.R.
        • Hochman J.S.
        Cardiogenic shock.
        Circulation. 2008; 117: 686-697
        • Schumann J.
        • Henrich E.C.
        • Strobl H.
        • et al.
        Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome.
        Cochrane Database Syst Rev. 2018; 1CD009669
        • Kettner J.
        • Sramko M.
        • Holek M.
        • Pirk J.
        • Kautzner J.
        Utility of intra-aortic balloon pump support for ventricular septal rupture and acute mitral regurgitation complicating acute myocardial infarction.
        Am J Cardiol. 2013; 112: 1709-1713
        • Rob D.
        • Špunda R.
        • Lindner J.
        • et al.
        A rationale for early extracorporeal membrane oxygenation in patients with postinfarction ventricular septal rupture complicated by cardiogenic shock.
        Eur J Heart Fail. 2017; 19: 97-103
        • Sheu J.-J.
        • Tsai T.-H.
        • Lee F.-Y.
        • et al.
        Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock.
        Crit Care Med. 2010; 38: 1810-1817
        • Arnaoutakis G.J.
        • Zhao Y.
        • George T.J.
        • Sciortino C.M.
        • McCarthy P.M.
        • Conte J.V.
        Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database.
        Ann Thorac Surg. 2012; 94 ([discussion 443-4]): 436-443
      2. La Torre MW, Centofanti P, Attisani M, Patanè F, Rinaldi M. Posterior ventricular septal defect in presence of cardiogenic shock: early implantation of the impella recover LP 5.0 as a bridge to surgery. Tex Heart Inst J. 2011;38(1):42–49.

        • Ng R.
        • Yeghiazarians Y.
        Post myocardial infarction cardiogenic shock.
        J Intensive Care Med. 2013; 28: 151-165
        • Jones B.M.
        • Kapadia S.R.
        • Smedira N.G.
        • et al.
        Ventricular septal rupture complicating acute myocardial infarction: a contemporary review.
        Eur Heart J. 2014; 35: 2060-2068
        • Kutty R.S.
        • Jones N.
        • Moorjani N.
        Mechanical complications of acute myocardial infarction.
        Cardiol Clin. 2013; 31 ([vii-viii]): 519-531
        • Jacobs A.K.
        • Leopold J.A.
        • Bates E.
        • et al.
        Cardiogenic shock caused by right ventricular infarction: a report from the SHOCK registry.
        J Am Coll Cardiol. 2003; 41: 1273-1279
        • Ventetuolo C.E.
        • Klinger J.R.
        Management of acute right ventricular failure in the intensive care unit.
        Ann Am Thorac Soc. 2014; 11: 811-822
        • Wilcox S.R.
        • Kabrhel C.
        • Channick R.N.
        Pulmonary hypertension and right ventricular failure in emergency medicine.
        Ann Emerg Med. 2015; 66: 619-628
        • Price L.C.
        • Wort S.J.
        • Finney S.J.
        • Marino P.S.
        • Brett S.J.
        Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review.
        Crit Care. 2010; 14: R169
        • Currigan D.A.
        • Hughes R.J.A.
        • Wright C.E.
        • Angus J.A.
        • Soeding P.F.
        Vasoconstrictor responses to vasopressor agents in human pulmonary and radial arteries: an in vitro study.
        Anesthesiology. 2014; 121: 930-936
        • Rich S.
        • Gubin S.
        • Hart K.
        The effects of phenylephrine on right ventricular performance in patients with pulmonary hypertension.
        Chest. 1990; 98: 1102-1106
        • Hoeper M.M.
        • Granton J.
        Intensive care unit management of patients with severe pulmonary hypertension and right heart failure.
        Am J Respir Crit Care Med. 2011; 184: 1114-1124

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