323. Beyond the Boards: Complications of Acute Myocardial Infarction with Dr. Jeffrey Geske

Mechanical complications following myocardial infarction, such as cardiogenic shock, ventricular septal defects (VSD), and papillary muscle rupture, require rapid, multidisciplinary intervention. Sinus tachycardia in the setting of acute infarction serves as a critical warning sign, often signaling impending cardiogenic shock where high-dose beta-blockade can prove detrimental. Bedside echocardiography is the essential diagnostic tool for distinguishing between these mechanical failures, particularly when hemodynamic instability arises days post-infarction. While surgical repair remains the standard of care for ruptures, the timing and choice of mechanical circulatory support—such as Impella or intra-aortic balloon pumps—depend on individual patient anatomy and institutional protocols. Dr. Jeffrey Geske, an advanced cardiovascular imaging specialist at the Mayo Clinic, emphasizes that because tissue integrity is severely compromised in the days following an infarct, early identification and swift surgical consultation are vital to improving patient outcomes.