ST elevation myocardial infarction initial care: Difference between revisions
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===Overview of Initial Therapies=== | ===Overview of Initial Therapies=== | ||
Initial therapies include [[ST elevation myocardial infarction oxygen therapy|oxygen]], [[ST elevation myocardial infarction aspirin therapy|aspirin]], [[ST elevation myocardial infarction nitrate therapy|nitroglycerin or glyceryl trinitrate]] (excluding though those patients with a [[Right Ventricular Myocardial Infarction|right ventricular myocardial infarction]]) and [[ST elevation myocardial infarction analgesic therapy|analgesia]] (usually [[ST elevation myocardial infarction analgesic therapy|morphine]]). Morphine is the preferred analgesic agent due to its ability to reduce adrenergic drive and reduce [[preload]] (it is a venodilator). [[ST elevation myocardial infarction analgesic therapy|NSAIDs and COX-2 inhibitors]] should be discontinued due to their association with higher rates of adverse events.<ref>C. Michael Gibson, Yuri B. Pride, Philip E. Aylward, Jacques J. Col, Shaun G. Goodman, Dietrich Gulba, Mijo Bergovec, Vijayalakshmi Kunadian, Cafer Zorkun, Jacqueline L. Buros, Sabina A. Murphy and Elliott M. Antman.Association of non-steroidal anti-inflammatory drugs with outcomes in patients with ST-segment elevation myocardial infarction treated with fibrinolytic therapy: an ExTRACT-TIMI 25 analysis. [http://www.springerlink.com/content/7018386828102397/?p=af9fdade1d8b42da8c3b3922acb7748b&pi=1 DOI10.1007/s11239-008-0264-4].</ref> <ref name="pmid16675319">{{cite journal |author=Gaziano JM, Gibson CM |title=Potential for drug-drug interactions in patients taking analgesics for mild-to-moderate pain and low-dose aspirin for cardioprotection |journal=Am. J. Cardiol. |volume=97 |issue=9A |pages=23–9 |year=2006 |month=May |pmid=16675319 |doi=10.1016/j.amjcard.2006.02.020 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(06)00218-9}}</ref> The antiplatelet agent [[ST elevation myocardial infarction aspirin therapy|aspirin]] has been associated with a reduction in mortality.<ref name="pmid2899772">{{cite journal |author= |title=Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group |journal=Lancet |volume=2 |issue=8607 |pages=349–60 |year=1988 |month=August |pmid=2899772 |doi= |url=}}</ref> | Initial therapies include [[ST elevation myocardial infarction oxygen therapy|oxygen]], [[ST elevation myocardial infarction aspirin therapy|aspirin]], [[ST elevation myocardial infarction nitrate therapy|nitroglycerin or glyceryl trinitrate]] (excluding though those patients with a [[Right Ventricular Myocardial Infarction|right ventricular myocardial infarction]]) and [[ST elevation myocardial infarction analgesic therapy|analgesia]] (usually [[ST elevation myocardial infarction analgesic therapy|morphine]]). Morphine is the preferred analgesic agent due to its ability to reduce adrenergic drive and reduce [[preload]] (it is a venodilator). [[ST elevation myocardial infarction analgesic therapy|NSAIDs and COX-2 inhibitors]] should be discontinued due to their association with higher rates of adverse events.<ref>C. Michael Gibson, Yuri B. Pride, Philip E. Aylward, Jacques J. Col, Shaun G. Goodman, Dietrich Gulba, Mijo Bergovec, Vijayalakshmi Kunadian, Cafer Zorkun, Jacqueline L. Buros, Sabina A. Murphy and Elliott M. Antman.Association of non-steroidal anti-inflammatory drugs with outcomes in patients with ST-segment elevation myocardial infarction treated with fibrinolytic therapy: an ExTRACT-TIMI 25 analysis. [http://www.springerlink.com/content/7018386828102397/?p=af9fdade1d8b42da8c3b3922acb7748b&pi=1 DOI10.1007/s11239-008-0264-4].</ref> <ref name="pmid16675319">{{cite journal |author=Gaziano JM, Gibson CM |title=Potential for drug-drug interactions in patients taking analgesics for mild-to-moderate pain and low-dose aspirin for cardioprotection |journal=Am. J. Cardiol. |volume=97 |issue=9A |pages=23–9 |year=2006 |month=May |pmid=16675319 |doi=10.1016/j.amjcard.2006.02.020 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(06)00218-9}}</ref> The antiplatelet agent [[ST elevation myocardial infarction aspirin therapy|aspirin]] has been associated with a reduction in mortality and has limited adverse effects. <ref name="pmid2899772">{{cite journal |author= |title=Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group |journal=Lancet |volume=2 |issue=8607 |pages=349–60 |year=1988 |month=August |pmid=2899772 |doi= |url=}}</ref> Full dose non-enteric coated aspirin (162 mg to 325 mg) should be administered to a STEMI patient who does not have a history of hypersensitivity to ASA as soon as possible. In the absence of cardiogenic shock or heart failure, a beta blocker should also be initiated. | ||
Once the diagnosis of myocardial infarction is confirmed | Once the diagnosis of myocardial infarction is confirmed and diagnoses that would contraindicate the administration of antithrombins such as [[aortic dissection]] and [[pericarditis]] have been excluded, [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|antithrombin]] therapy should be initiated. <ref name="pmid15289388">{{cite journal |author=Antman EM, Anbe DT, Armstrong PW, ''et al'' |title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) |journal=Circulation |volume=110 |issue=5 |pages=588–636 |year=2004 |month=August |pmid=15289388 |doi=10.1161/01.CIR.0000134791.68010.FA |url=}}</ref> | ||
==[[ST Elevation Myocardial Infarction Initial Care|Initial Care]]== | ==[[ST Elevation Myocardial Infarction Initial Care|Initial Care]]== | ||
Revision as of 13:53, 26 April 2009
| Myocardial infarction | |
| ICD-10 | I21-I22 |
|---|---|
| ICD-9 | 410 |
| DiseasesDB | 8664 |
| MedlinePlus | 000195 |
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 Discuss ST elevation myocardial infarction initial care further in the WikiDoc Cardiology Network |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
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The goal of initial care of the STEMI patient is to restore epicardial artery patency as rapidly and fully as possible, and to reduce the risk of early vessel reocclusion. Other goals include reducing the risk of lethal ventricular arrhythmias and other mechanical complications as well as reducing myocardial oxygen demands to limit infarct size with beta blockers.
Overview of Initial Therapies
Initial therapies include oxygen, aspirin, nitroglycerin or glyceryl trinitrate (excluding though those patients with a right ventricular myocardial infarction) and analgesia (usually morphine). Morphine is the preferred analgesic agent due to its ability to reduce adrenergic drive and reduce preload (it is a venodilator). NSAIDs and COX-2 inhibitors should be discontinued due to their association with higher rates of adverse events.[1] [2] The antiplatelet agent aspirin has been associated with a reduction in mortality and has limited adverse effects. [3] Full dose non-enteric coated aspirin (162 mg to 325 mg) should be administered to a STEMI patient who does not have a history of hypersensitivity to ASA as soon as possible. In the absence of cardiogenic shock or heart failure, a beta blocker should also be initiated.
Once the diagnosis of myocardial infarction is confirmed and diagnoses that would contraindicate the administration of antithrombins such as aortic dissection and pericarditis have been excluded, antithrombin therapy should be initiated. [4]
Initial Care
Oxygen | Nitrates | Analgesics | Aspirin | Beta Blockers | The coronary care unit
References
- ↑ C. Michael Gibson, Yuri B. Pride, Philip E. Aylward, Jacques J. Col, Shaun G. Goodman, Dietrich Gulba, Mijo Bergovec, Vijayalakshmi Kunadian, Cafer Zorkun, Jacqueline L. Buros, Sabina A. Murphy and Elliott M. Antman.Association of non-steroidal anti-inflammatory drugs with outcomes in patients with ST-segment elevation myocardial infarction treated with fibrinolytic therapy: an ExTRACT-TIMI 25 analysis. DOI10.1007/s11239-008-0264-4.
- ↑ Gaziano JM, Gibson CM (2006). "Potential for drug-drug interactions in patients taking analgesics for mild-to-moderate pain and low-dose aspirin for cardioprotection". Am. J. Cardiol. 97 (9A): 23–9. doi:10.1016/j.amjcard.2006.02.020. PMID 16675319. Unknown parameter
|month=ignored (help) - ↑ "Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group". Lancet. 2 (8607): 349–60. 1988. PMID 2899772. Unknown parameter
|month=ignored (help) - ↑ Antman EM, Anbe DT, Armstrong PW; et al. (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)". Circulation. 110 (5): 588–636. doi:10.1161/01.CIR.0000134791.68010.FA. PMID 15289388. Unknown parameter
|month=ignored (help)
External links
- The MD TV: Comments on Hot Topics, State of the Art Presentations in Cardiovascular Medicine, Expert Reviews on Cardiovascular Research
- Clinical Trial Results: An up to date resource of Cardiovascular Research
- Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack - based on information of the Framingham Heart Study, from the United States National Heart, Lung and Blood Institute
- Heart Attack - overview of resources from MedlinePlus.
- Heart Attack Warning Signals from the Heart and Stroke Foundation of Canada
- Regional PCI for STEMI Resource Center - Evidence based online resource center for the development of regional PCI networks for acute STEMI
- STEMI Systems - Articles, profiles, and reviews of the latest publications involved in STEMI care. Quarterly newsletter.
- American College of Cardiology (ACC) Door to Balloon (D2B) Initiative.
- American Heart Association's Heart Attack web site - Information and resources for preventing, recognizing and treating heart attack.