ST elevation myocardial infarction initial care
| Myocardial infarction | |
| ICD-10 | I21-I22 |
|---|---|
| ICD-9 | 410 |
| DiseasesDB | 8664 |
| MedlinePlus | 000195 |
| eMedicine | med/1567 emerg/327 ped/2520 |
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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 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.
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.[3]
Once the diagnosis of myocardial infarction is confirmed, additional pharmacologic agents may then be administered. These include beta blockers[4][5] and anticoagulation therapy (typically with an antithrombin)[6]
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) - ↑ "Randomised trial of intravenous atenolol among 16 027 cases of suspected acute myocardial infarction: ISIS-1. First International Study of Infarct Survival Collaborative Group". Lancet. 2 (8498): 57–66. 1986. PMID 2873379. Unknown parameter
|month=ignored (help) - ↑ "Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) phase II trial. The TIMI Study Group". N. Engl. J. Med. 320 (10): 618–27. 1989. PMID 2563896. 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.