Long-Term Consequences and Prognosis After Myocardial Infarction

Introduction

Substantial changes in cardiac structure can occur in the months to years following a completed myocardial infarct (MI), particularly if the culprit coronary artery supplied a large territory or flow was not rapidly restored. These changes may be clinically silent as they evolve, but with time can lead to extensive morbidity and mortality, including increased risk of developing heart failure and sudden cardiac death (SCD). Most of the pharmacologic, electrophysiologic, and interventional therapies indicated following MI are targeted toward prevention or amelioration of these complications. Both common and rare long-term complications after MI are summarized in Box. 20.1 . Most of these complications occur more commonly after large transmural infarcts, where revascularization was unsuccessful.

Echocardiography is appropriately used for the initial evaluation of ventricular function following an acute coronary syndrome (ACS), but is also very useful during the recovery phase to guide therapy (see Chapter 47 ). For the chronic care of patients with coronary artery disease, deterioration in clinical status or physical exam (without a clear precipitating change in medication or diet), or intent to initiate or change therapy because of clinical status change is also grounds for a cardiac ultrasound. Echocardiography can also supply much prognostic data with respect to patient trajectory and outcomes.