Acute Myocardial Infarction

Joseph D. Lynch, MD

Acute Myocardial Infarction

• Mechanism

• Clinical Presentation

• Diagnosis

• Management

0%10%20%30%40%

Pre-CCU era CCU era Reperfusionera

30%

Defibrillation, hemodynamic monitoring,

ß blockade

15%Thrombolysis/PTCA, ASA

6.5%

Short Term Mortality,

%

Diagnosis of Myocardial Infarction

• Clinical Presentation

• Electrocardiogram

• Cardiac Markers

Management

• Pre-Hospital

• Emergency Department

• First 24 hours

• ST segment elevation infarction

Open vessel

• Non ST segment elevation infarction

Aspirin

Heparin

Etc.

(Keep vessel open)

Early Issues

• Oxygen

• Nitroglycerin

• Aspirin

• Thrombolysis

• Primary PTCA

• Early Angiography

• Urgent CABG

Additional Drugs

• Heparin

• Beta Blocking Agents

• Ace Inhibitor

• Calcium Channel Blocker

Hospital Management

• Monitor

• Rest

• Pain Control

• Swan Ganz Catheter

• Lamp

• Arrhythmias

• Pacemakers

Complications of Infarction

• Arrhythmias• Pump Failure• Emboli• Pericarditis• Papillary Muscle Dysfunction• Ventricular Septal Rupture• LV Wall Rupture• LV Aneurysm

• After 24 Hours

• Pre-discharge Preparation

• Long-Term Management

Long Term Medications

• Beta Blocker

• Ace Inhibitors

• Aspirin

• Anticoagulants

• Statins