ST elevation myocardial infarction initial care: Difference between revisions
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===Overview of Initial Therapies=== | ===Overview of Initial Therapies=== | ||
Initial therapies include [[oxygen first aid|Oxygen]], [[aspirin]], [[glyceryl trinitrate (pharmacology)|glyceryl trinitrate]] (nitroglycerin) (excluding though those patients with a [[Right Ventricular Myocardial Infarction|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). The antiplatelet agent aspirin has been associated with a reduction in mortality.<ref name=" | Initial therapies include [[oxygen first aid|Oxygen]], [[aspirin]], [[glyceryl trinitrate (pharmacology)|glyceryl trinitrate]] (nitroglycerin) (excluding though those patients with a [[Right Ventricular Myocardial Infarction|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). The antiplatelet agent 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> | ||
Once the diagnosis of myocardial infarction is confirmed, additional pharmacologic agents may then be administered. These include [[beta blocker]]s<ref name=" | Once the diagnosis of myocardial infarction is confirmed, additional pharmacologic agents may then be administered. These include [[beta blocker]]s<ref name="pmid2873379">{{cite journal |author= |title=Randomised trial of intravenous atenolol among 16 027 cases of suspected acute myocardial infarction: ISIS-1. First International Study of Infarct Survival Collaborative Group |journal=Lancet |volume=2 |issue=8498 |pages=57–66 |year=1986 |month=July |pmid=2873379 |doi= |url=}}</ref><ref name="pmid2563896">{{cite journal |author= |title=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 |journal=N. Engl. J. Med. |volume=320 |issue=10 |pages=618–27 |year=1989 |month=March |pmid=2563896 |doi= |url=}}</ref> and anticoagulation therapy (typically with an antithrombin)<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> | ||
Wiki''doc'' cites here the ACC / AHA Guidelines Based Therapy for ST Elevation MI <ref name=" | Wiki''doc'' cites here the ACC / AHA Guidelines Based Therapy for ST Elevation MI <ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref> | ||
'''DO NOT EDIT THESE GUIDELINES'''. You can make comments regarding the guidelines in the discussion section. | '''DO NOT EDIT THESE GUIDELINES'''. You can make comments regarding the guidelines in the discussion section. | ||
Revision as of 19:27, 11 February 2009
| Myocardial infarction | |
| ICD-10 | I21-I22 |
|---|---|
| ICD-9 | 410 |
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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 reducing myocardial oxygen demands.
Overview of Initial Therapies
Initial therapies include Oxygen, aspirin, glyceryl trinitrate (nitroglycerin) (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). The antiplatelet agent aspirin has been associated with a reduction in mortality.[1]
Once the diagnosis of myocardial infarction is confirmed, additional pharmacologic agents may then be administered. These include beta blockers[2][3] and anticoagulation therapy (typically with an antithrombin)[4]
Wikidoc cites here the ACC / AHA Guidelines Based Therapy for ST Elevation MI [5]
DO NOT EDIT THESE GUIDELINES. You can make comments regarding the guidelines in the discussion section.
Interpreting the ACC / AHA Guidelines
Oxygen
Nitrates
Analgesics
Aspirin
Beta Blockers
Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)
Fibrinolysis
Primary PCI
Adjunctive and Rescue PCI
CABG
Management of Patients Who Were Not Reperfused
Assessing Success of Reperfusion
Antithrombin Therapy (Overview)
Unfractionated Heparin (UFH) Therapy
Low Molecular Weight Heparinoid Therapy
Direct Thrombin Inhibitor Therapy
Antiplatelet Agents
Aspirin
Thienopyridine Therapy
Glycoprotein IIbIIIa Inhibition
Inhibition of the Renin-Angiotensin-Aldosterone System
Magnesium Therapy
Glucose Control
Calcium Channel Blocker Therapy
See also
- acute coronary syndrome
- angina
- Cardiac arrest
- coronary thrombosis
- Hibernating myocardium
- Stunned myocardium
- Ventricular remodeling
References
- ↑ "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) - ↑ Antman EM, Hand M, Armstrong PW; et al. (2008). "2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee". Circulation. 117 (2): 296–329. doi:10.1161/CIRCULATIONAHA.107.188209. PMID 18071078. 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 dated 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.