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Mechanical and electrical complications of a myocardial infarction (MI)

Writer: MaytaMayta
Jan 16, 20241 min read

performing a targeted physical examination is crucial for identifying the mechanical and electrical complications of a myocardial infarction (MI). Here is a guide for the physical examination tailored to each of these complications:

Mechanical Complications

1. Ventricular Septal Rupture

• Auscultation: Harsh, loud holosystolic murmur best heard at the left lower sternal border.

• Palpation: Palpable thrill may be present over the murmur site.

2. Papillary Muscle Rupture

• Auscultation: New systolic murmur indicative of mitral regurgitation, best heard at the apex and radiating to the axilla.

• Observation: Signs of acute heart failure like pulmonary edema.

3. Left Ventricular Free Wall Rupture

• Observation: Rapid hemodynamic collapse, signs of shock.

• Palpation: Distended neck veins indicating cardiac tamponade.

• Auscultation: Distant or muffled heart sounds.

4. Ventricular Aneurysm

• Auscultation: May hear a murmur of mitral regurgitation or arrhythmias.

• Palpation: Abnormal pulse rate or rhythm.

• Observation: Signs of heart failure or embolic events.

Electrical Complications

1. Arrhythmias

• Palpation: Irregular pulse, rapid or slow depending on the type of arrhythmia.

• Auscultation: Irregular heart rhythm.

2. Heart Block

• Palpation: Slow pulse rate, possible irregularity.

• Observation: Symptoms of dizziness or syncope due to bradycardia.

3. Sinus Bradycardia

• Palpation: Slow but regular pulse.

• Observation: May have symptoms like fatigue, dizziness, or lightheadedness.

4. Atrial Fibrillation

• Palpation: Rapid, irregular pulse.

• Auscultation: Irregularly irregular rhythm without a consistent pattern.

For all these complications, the physical examination findings must be interpreted in the context of the patient’s clinical presentation and history. Additionally, confirmatory diagnostics like echocardiography and electrocardiography (ECG) are essential for accurate diagnosis and appropriate management.

 
 
 

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Post: Blog2_Post

Message for International Readers
Understanding My Medical Context in Thailand

By Uniqcret, M.D.
 

Dear readers,
 

My name is Uniqcret, which is my pen name used in all my medical writings. I am a Doctor of Medicine trained and currently practicing in Thailand, a developing country in Southeast Asia.
 

The medical training environment in Thailand is vastly different from that of Western countries. Our education system heavily emphasizes rote memorization—those who excel are often seen as "walking encyclopedias." Unfortunately, those who question, critically analyze, or solve problems efficiently may sometimes be overlooked, despite having exceptional clinical thinking skills.
 

One key difference is in patient access. In Thailand, patients can walk directly into tertiary care centers without going through a referral system or primary care gatekeeping. This creates an intense clinical workload for doctors and trainees alike. From the age of 20, I was already seeing real patients, performing procedures, and assisting in operations—not in simulations, but in live clinical situations. Long work hours, sometimes exceeding 48 hours without sleep, are considered normal for young doctors here.
 

Many of the insights I share are based on first-hand experiences, feedback from attending physicians, and real clinical practice. In our culture, teaching often involves intense feedback—what we call "โดนซอย" (being sliced). While this may seem harsh, it pushes us to grow stronger, think faster, and become more capable under pressure. You could say our motto is “no pain, no gain.”
 

Please be aware that while my articles may contain clinically accurate insights, they are not always suitable as direct references for academic papers, as some content is generated through AI support based on my knowledge and clinical exposure. If you wish to use the content for academic or clinical reference, I strongly recommend cross-verifying it with high-quality sources or databases. You may even copy sections of my articles into AI tools or search engines to find original sources for further reading.
 

I believe that my knowledge—built from real clinical experience in a high-intensity, under-resourced healthcare system—can offer valuable perspectives that are hard to find in textbooks. Whether you're a student, clinician, or educator, I hope my content adds insight and value to your journey.
 

With respect and solidarity,

Uniqcret, M.D.

Physician | Educator | Writer
Thailand

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