Patient handout

STEMI complicated by mechanical complication (PMR / VSR / free-wall rupture)

PRODUCTION

1. Your condition

This handout is for stemi complicated by mechanical complication (pmr / vsr / free-wall rupture). Your care team identified this based on: new harsh holosystolic murmur 2-7 d post-mi ± hemodynamic deterioration → pmr or vsr until proven otherwise.

Other reasons your team may use this plan: stat echo: acute severe mr (flail leaflet, eccentric jet, hyperdynamic lv) or vsr jet on color doppler post-mi; sudden hemodynamic collapse + new pericardial effusion 1-7 d post-mi → free-wall rupture / pseudoaneurysm / tamponade.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	162-325 mg chewed	PO	load + 81 mg daily	ACC/AHA 2025 ACS Class I; same as parent — continue through surgery if PCI completed
ticagrelor	180 mg load → 90 mg BID; HOLD if CABG decided pre-load (use cangrelor bridge or no load)	PO	BID	PLATO PMID 19717846; same as parent; held if CABG planned within 5-7 d
nitroprusside	0.3 mcg/kg/min titrate to MAP 65-75	IV	continuous infusion	Afterload reduction reduces regurgitant fraction in acute severe MR; ESC 2023 ACS expert consensus; only if SBP permits (avoid if SCAI C-E shock without MCS)
norepinephrine	0.05-0.5 mcg/kg/min titrate to MAP 65	IV	continuous infusion	SOAP-II PMID 20200382 — first-line vasopressor for cardiogenic shock; bridges to MCS
milrinone	0.125-0.5 mcg/kg/min (no bolus in shock)	IV	continuous infusion	Inodilator with pulmonary vasodilation — useful for biventricular failure or RV dysfunction; ESC HF 2021

Plan: STEMI mechanical complication overlay — adds MCS bridging + afterload reduction + surgical bridging anticoagulation to parent cardio.stemi.core.v1 reperfusion regimen

3. When to call your provider

Contact your care team if any of the following happen:

ICD therapy delivered → urgent EP
Prosthetic dysfunction → cardiac surgery
New symptoms suggesting recurrent MR/VSR → STAT echo

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Sudden hemodynamic collapse + new pericardial effusion + tamponade physiology 1-7 d post-MI → free-wall rupture(life-threatening)
New harsh holosystolic murmur + flash pulmonary edema + flail leaflet on echo → papillary muscle rupture (typically posteromedial in inferior MI from PDA territory)(life-threatening)
New harsh holosystolic murmur + hemodynamic deterioration + O2 step-up ≥7% RA→RV at right heart cath OR jet across septum on TEE → VSR(life-threatening)
Mechanical complication + SCAI D (deteriorating) or E (extremis) shock — biventricular failure, refractory hypotension despite max vasopressors(life-threatening)
Subacute free-wall rupture contained by pericardium → pseudoaneurysm on echo days-weeks post-MI; high rupture risk

5. Follow-up

Cardiology + cardiac surgery follow-up; echo at 30-90 d for repair durability + heart pumping strength (LVEF) reassessment; ICD eligibility per MADIT-II if EF <30; cardiac rehab

6. Sources

Guideline: 2025 ACC/AHA ACS Guideline + ESC 2023 ACS + SCAI 2022 CS staging