MI Mechanical Complications - Instant Feedback

Papillary Rupture: Mitral Regurgitation. Often described as "New onset systolic murmur" with "Crackles/Pulmonary Edema."
Septal Rupture: VSD. Often described as "Holosystolic murmur at sternal border" with a "Thrill."

Papillary Muscle Rupture: Occurs in 3-5 days. The mitral valve fails acutely → blood floods the lungs (Pulmonary Edema).
Key Association: RCA feeds the posteromedial papillary muscle (which has a single blood supply, making it prone to rupture).

Interventricular Septum Rupture: Occurs in 3-5 days. High pressure LV blood blasts into the RV.
Diagnostic Key: O2 Step-up (Oxygen is higher in RV than RA).

Free Wall Rupture: 5 days - 2 weeks. The wall gives way → blood fills the pericardial sac (Tamponade).
Signs: Beck's Triad (Distant heart sounds). Rapid progression to PEA arrest.

Left Ventricular Aneurysm: Occurs months later. A scar forms and bulges.
Risk: Blood pools in the bulge → Thrombus → Stroke. Also causes persistent ST Elevation.

Complication	Time Course	Clinical Findings	Notes
Papillary Muscle Rupture	Acute (3-5 days)	Severe pulmonary edema, New Early Systolic Murmur	Usually RCA occlusion
IV Septum Rupture	Acute (3-5 days)	New Holosystolic Murmur, Step up in O2 (RA->RV)	LAD or RCA
Free Wall Rupture	Within 5 days - 2 weeks	Distant heart sounds, Shock, Cardiac Arrest (Tamponade)	Usually LAD occlusion
LV Aneurysm	Several Months	Heart failure, Angina, Arrhythmias	Usually LAD occlusion

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Reference Table

Step 1 "Big Picture" Logic