How would you manage a patient with acute MI ?
Treatment of MI includes (BMJ 1998; 316: 280-4):
• In the A&E department, a patient with chest pain should have a quick clinical examination and an ECG performed within l0 minutes of arrival in hospital.
• Aspirin: chewable non-coated 160-325 mg should be administered immediately and then 160-325 mg daily. In the ISIS-2 and ISlS-3 trials 160 mg dosage was effective whereas a 325 mg dose was used successfully in G1SSI-2. An initial large dose of aspirin of 325 mg orally or 160 mg chewable aspirin is preferred because lower doses may still allow significant thromboxane activity and may take a few days to become effective.
• Pain relief: immediate relief of pain should be a top priority because severe pain can cause
autonomic disturbances that can result in sudden death.
• Reperfusion strategies: either thrombolysis or primary PTCA should be per-formed within 30 minutes of the patient's arrival in hospital.
• Beta-blockers: the patient should receive beta-blockers when there are no contra-indications within 12 hours of onset of infarction, irrespective of administration of concomitant thrombolytic therapy or performance of primary angioplasty.
• ACE inhibitors: should be administered within the first 24 hours of a suspected acute myocardial infarction with ST segment elevation in > 2 anterior precordial leads or with clinical heart failure in the absence of hypotension (systolic blood pressure <100 mmHg) or known contraindications to use of ACE inhibitors.
Lexo edhe:
Treatment of MI includes (BMJ 1998; 316: 280-4):
• In the A&E department, a patient with chest pain should have a quick clinical examination and an ECG performed within l0 minutes of arrival in hospital.
• Aspirin: chewable non-coated 160-325 mg should be administered immediately and then 160-325 mg daily. In the ISIS-2 and ISlS-3 trials 160 mg dosage was effective whereas a 325 mg dose was used successfully in G1SSI-2. An initial large dose of aspirin of 325 mg orally or 160 mg chewable aspirin is preferred because lower doses may still allow significant thromboxane activity and may take a few days to become effective.
• Pain relief: immediate relief of pain should be a top priority because severe pain can cause
autonomic disturbances that can result in sudden death.
• Reperfusion strategies: either thrombolysis or primary PTCA should be per-formed within 30 minutes of the patient's arrival in hospital.
• Beta-blockers: the patient should receive beta-blockers when there are no contra-indications within 12 hours of onset of infarction, irrespective of administration of concomitant thrombolytic therapy or performance of primary angioplasty.
• ACE inhibitors: should be administered within the first 24 hours of a suspected acute myocardial infarction with ST segment elevation in > 2 anterior precordial leads or with clinical heart failure in the absence of hypotension (systolic blood pressure <100 mmHg) or known contraindications to use of ACE inhibitors.
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Lexo edhe:
