M.I
Causes
Rh. - infective endocarditis
organic M. V. prolapsed
Ischaemic ischaemic papillary mus
HOCM – Marfan syndrome
Functional due to dill of Lf. V e.g on top of A.I, myocarditis or
dilated cardiomyopathy.
Heamodynamics
M.I regurge to L.A ++ blood flow Lt. V.
V.L on Lt. V. Lt. V. dil late failure P. V. C.
Q.
patient with M. I Å P.V.C. !?

associated M.I. M.I

M. S. Lt. V. failure regurged blood
Late to Lt. atr. pr

Lt. V. dilatation is late mild P.V.C.
because
blood has 2 pathways


to the low pr. of the Lt. atrium & to the
­ pr. of Aorta

C/P
1. Palpitation: due to volume overload
2. P.V.C as a direct result of M.I or secondarily to Lt.V failure
3.
¯ cop. esp. with severe cases.

O/E
local
· insp. & palp.:- it. V. + +
apex hyper dynamic.
syst thrill on the apex
· Auscult. S1¯

N.B. S
2 PVC. P++ ­S2

Soft blowing S
3 Lt. V.F. (late)
Pansystolic murmur Or due to overflow to the Lt .V.
max. intensity over S
4 over tricuspid. d.t. P++ , late.
the apex = M.I.
¤ murmur, post. leaflet M.I.
murmur (apex) Lt. parasternal
like VSD, but the maximum intensity
on the apex

Investigations
s X-ray - ECG Lt.V.++, left Atrial dilatation
s echo diag. M. I. , chamber ++ severity of M.I


Treatment

s Mild mild symp
No
¯ COP medical
Lt. V. not dilated (apex 5th ) Rh.F. ttt P.V.C. endocard
itis
echo as M.S. prophylaxis

s Severe V.R

Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)