MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS PRESENTING WITH ST-SEGMENT ELEVATION

Abstract

Introduction     The definition of acute myocardial infarction     The pathogenesis of acute myocardialinfarction     The natural history of acute myocardial infarction     Aims of management Emergency care     Initial diagnosis and early risk stratification     Relief of pain, breathlessness and anxiety     Cardiac arrest     Basic life support     Advanced life support Pre-hospital or early in-hospital care     Restoring coronary flow and myocardial tissue reperfusion     Fibrinolytic treatment     Fibrinolytic regimens     Percutaneous coronary interventions (PCI)     Primary PCI     PCI combined with fibrinolysis     ‘Rescue’ PCI     Assessing myocardial salvage by fibrinolysis or PCI     GP IIb/IIIa antagonists and early PCI     Coronary artery bypass surgery     Pump failure and shock     Heart failure     Mild and moderately severe heart failure     Severe heart failure and shock     Mechanical complications: cardiac rupture and mitral regurgitation     Free wall rupture     Ventricular septal rupture     Mitral regurgitation     Arrhythmias and conduction disturbances     Ventricular arrhythmias     Supraventricular arrhythmias     Sinus bradycardia and heart block     Routine prophylactic therapies in the acute phase     Management of specific types of infarction     Right ventricular infarction     Myocardial infarction in diabetic patients Management of the later in-hospital course     Ambulation     Management of specific in-hospital complications     Deep vein thrombosis and pulmonary embolism     Intraventricular thrombus and systemic emboli     Pericarditis     Late ventricular arrhythmias     Post-infarction angina and ischaemia Risk assessment, rehabilitation and secondary prevention     Risk assessment     Timing     Clinical assessment and further investigations     Assessment of myocardial viability, stunning and hibernation     Evaluation of risk of arrhythmia     Rehabilitation     Secondary prevention Logistics of care     Pre-hospital care     The coronary (cardiac) care unit (CCU) The current use of therapies tested by clinical trials Recommendations References The management of acute myocardial infarction continues to undergo major changes. Good practice should be based on sound evidence derived from well-conducted clinical trials. Because of the great number of trials on new treatments performed in recent years and because of new diagnostic tests, the European Society of Cardiology decided that it was opportune to upgrade the 1996 guidelines and appointed a Task …