Acute Myocardial Infarction Treatment. Treatment of acute myocardial infarction is the use of antiplatelet drugs, anticoagulants, nitrates, beta-blockers, statins, and reperfusion therapy. Management is divided into; Immediate prehospital management, Further Management, Difficult Situation management.
Full Answer
What are the treatment options for acute myocardial infarction?
The management of AMI aims to reduce myocardial ischemia and subsequent morbidity and mortality. International guidelines recommend improving myocardial perfusion or decreasing the cardiac workload using a combination of therapies known as MONA: morphine, oxygen, nitrates, and aspirin. 1,2
What is acute myocardial infarction (AMI)?
Acute Myocardial Infarction (AMI) also known as a heart attack is caused by the complete or partial occlusion of a coronary artery and requires prompt hospitalization and extensive care management. It is part of a spectrum of conditions that result from myocardial ischemia known as an acute coronary syndrome.
What is the role of oxygen in Ami treatment?
Oxygen, via face mask or nasal cannula, is often administered to patients with suspected AMI in an attempt to increase myocardial oxygenation and decrease infarct size. 1 According to Dion Stub, MBBS, PhD, from The Alfred Hospital in Melbourne, Australia, treating AMI with oxygen has its roots in practices dating back more than a century.
What are the treatment options for ST-segment elevation myocardial infarction (STEMI)?
For STEMI patients, emergency PCI is the preferred treatment of ST-segment elevation myocardial infarction. Reperfusion using fibrinolytics is most effective if given in the first few minutes to hours after the onset.
Which treatment has the best benefit for myocardial infarction?
All patients with a suspected myocardial infarction should be given aspirin. It is a powerful antiplatelet drug, with a rapid effect, which reduces mortality by 20%. Aspirin, 150-300 mg, should be swallowed as early as possible.
What is the standard treatment for an acute myocardial infarction?
Despite the absence of definitive outcome data, it is reasonable to treat the patient with acute MI and without hypotension, bradycardia, or excessive tachycardia with intravenous nitroglycerin for 24 to 48 hours after hospitalization.
What drug classes are recommended in the long term treatment after an AMI?
Secondary preventive drug therapy, e.g. platelet inhibitors, statins, beta-blockers and angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor II blockers (ARB), is recommended following AMI to reduce the risk of new cardiovascular events and death [3–7].
What are the treatment modalities for acute myocardial ischemia?
Fibrinolytic therapy (FT) and Primary Percutaneous Coronary Intervention (P-PCI) are the two currently available modalities of reperfusion therapies. Both of these options are extensively studied.
What treatment is indicated in the first 12 hours of myocardial infarction?
Alteplase, reteplase and streptokinase need to be given within 12 hours of symptom onset, ideally within one hour. Tenecteplase should be given as early as possible and usually within six hours of symptom onset.
How does aspirin treat myocardial infarction?
Aspirin is effective in reducing the blood clots that are blocking a coronary artery during an acute heart attack. Anyone who has already had a heart attack, or who has an increased risk of having one in the future, should always carry a few non-coated adult aspirins with them.
What drugs reduce mortality after MI?
ACE inhibitors reduce mortality rates after myocardial infarction. Administer ACE inhibitors as soon as possible as long as the patient has no contraindications and remains in stable condition. ACE inhibitors have the greatest benefit in patients with ventricular dysfunction.
Which intervention has the greatest benefit to prevent recurrence of myocardial infarction?
Lifestyle modification is the first-line treatment for preventing recurrent MIs. It includes smoking cessation, physical activity, diet, weight management, and management of diabetes, lipids, and blood pressure.
What drugs are given after myocardial infarction?
Currently used post-MI drugs with immunomodulatory effects include platelet inhibitors (A), statins (B), beta-blockers (C), and drugs targeting the renin–angiotensin–aldosterone system (D), including angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, angiotensin receptor–neprilysin ...
Which medication is used to relieve ischemic pain and reduce myocardial demand?
Medications. Medications to treat myocardial ischemia include: Aspirin. A daily aspirin or other blood thinner can reduce your risk of blood clots, which might help prevent blockage of your coronary arteries.
What is the initial treatment for ACS?
Morphine (or fentanyl) for pain control, oxygen, sublingual or intravenous (IV) nitroglycerin, soluble aspirin 162-325 mg, and clopidogrel with a 300- to 600-mg loading dose are given as initial treatment.
Why is heparin used for myocardial infarction?
The roles of heparin and warfarin in reducing morbidity and mortality after acute myocardial infarction (AMI) are reviewed. Full-dose i.v. heparin, with or without thrombolytic therapy, is indicated for the prevention of reinfarction and thromboembolism after AMI.
What is the best treatment for ST-segment elevation?
Recanalization therapy (thrombolysis or primary angioplasty). For STEMI patients, emergency PCI is the preferred treatment of ST-segment elevation myocardial infarction. Reperfusion using fibrinolytics is most effective if given in the first few minutes to hours after the onset.
How to reduce heart rate with tachyarrhythmias?
Reduced oxygen demand by the myocardium. Treat any tachyarrhythmias. If still tachycardic, reduce heart rate using beta-blockers like Metoprolol or Esmolol. If pain is the cause, give cardiostable analgesics such as Diamorphine, Fentanyl, Morphine.
What is the name of the drug that is used to treat thrombocytopenia?
Anticoagulants: A heparin (unfractionated or low molecular weight heparin) or bivalirudin for patients with a history of heparin-induced thrombocytopenia. Glycoprotein IIb/IIIa inhibitor for some high-risk patients like the ones with recurrent ischemia, dynamic ECG changes, or hemodynamic instability.
How to improve patient morale after heart attack?
Regular exercise and altering the posture of patient help to overcome these problems and improve patient morale. Most patients able to sit up in chair and take a few steps within 24 hrs of heart attack. As the days in hospital pass, exercise increases but the patient must avoid undue tachycardia.
What should be done in the late phase of myocardial infarction?
Myocardial infarction treatment in late phase: Patient leaving hospital should be diagnosed, prescribed by drugs and level of exercise and activities permitted at home and the expected date of returning to work should be given.
What is mechanical support in STEMI?
Mechanical support in the setting of STEMI has long been an area of active research. Although recent studies have not supported the routine use of intra-aortic balloon pump for shock in the setting of AMI to reduce afterload and improve coronary blood flow, 19 interventionalists obviously continue to utilize mechanical support in "patients who need it." Many therapies have been studied to reduce myocardial injury in the setting of AMI, but recent data raise the question whether mechanical unloading of the ventricle prior to PCI may reduce myocardial injury. Although the concept of ventricular unloading is not new, 20 ventricular unloading with an intra-aortic balloon pump is minimal compared with LV assist devices (LVAD). There are multiple options to provide hemodynamic support in patients with AMI and cardiogenic shock, including peripheral and central venoarterial extracorporeal membrane oxygenation, TandemHeart device (peripheral LVAD) (CardiacAssist, Inc; Pittsburg, PA), Impella CP or 2.5 device (ABIOMED, Inc; Danvers, MA), or multiple different LVAD options for surgical placement. Preclinical research suggests unloading the ventricle may significantly improve hemodynamics and decrease infarct size. In a study of percutaneous left atrial to femoral artery bypass with a TandemHeart device for ventricular unloading in a porcine AMI model, 21 the 4 animals that underwent 120 minutes of mid-LAD occlusion were placed on a TandemHeart device for 30 minutes of additional occlusion time and had continued support during reperfusion. These animals had a 42% reduction in infarct size by cardiac enzymes and histological analysis compared with animals that experience only 120 minutes of ischemia followed by reperfusion alone. Analysis of the data revealed that mechanical unloading before reperfusion activates signaling pathways that protect against reperfusion injury in the non-infarct zone during AMI without any difference in the infarct zone.21 These findings suggest that reducing LV wall stress with a delay in reperfusion reduces myocardial damage after ischemia. Total circulatory support with a LVAD has also been shown to significantly decrease infarct size compared with partial circulatory support. 22 Venoarterial extracorporeal membrane oxygenation in a porcine model of AMI increased coronary blood flow and reduced intracardiac pressures. 23 However, peripheral and central venoarterial extracorporeal membrane oxygenation can be limited by LV distension due to increased LV pressures, resulting in pulmonary edema. LV venting remains an important technique to unload the LV in these patients when extracorporeal membrane oxygenation is utilized for hemodynamic support. 24 Finally, intracorporeal axial flow catheters, such as Impella, have been shown to significantly reduce infarct size in both sheep and porcine AMI models. 25,26 LV unloading with Impella 30 or 60 min prior to reperfusion reduced infarct size, increased cardioprotective signaling, and improved mitochondrial integrity. 26 Thus, Impella serves as an important option to interventional cardiologists to provide ventricular unloading in patients with cardiogenic shock due to AMI or other etiologies such as decompensated HF or recurrent ventricular tachycardia.
Why is ischemic preconditioning important?
The concept of ischemic preconditioning also has a clinical basis because patients with severe coronary stenoses often develop or recruit collaterals, which may minimize ischemic injury and reduce the development of fatal ventricular arrhythmias following acute vessel occlusion.
What is the best treatment for monomorphic ventricular tachycardia?
If monomorphic ventricular tachycardia is not accompanied by chest pain, pulmonary congestion, or hypotension, it should be treated with intravenous lidocaine, procainamide, or amiodarone. The patient with acute MI and symptomatic sinus bradycardia or atrioventricular block should receive atropine.
How long does it take to take a syringe for MI?
1. For the first 24 to 48 hours in all patients with acute MI who do not have hypotension, bradycardia, or tachycardia. 2. Continued use (beyond 48 hours)* in patients with a large or complicated infarction.
What is MI in medical terms?
1. When MI is suspected to have occurred by a mechanism other than thrombotic occlusion at an atherosclerotic plaque. This would include coronary embolism, certain metabolic or hematological diseases, or coronary artery spasm.
What is the AMI of CHD?
Acute myocardial infarction (AMI), which leads to myocardial injury and necrosis, is a common initial presentation of CHD and may recur over the course of the disease. 1. Cardiac ischemia may occur via many mechanisms, such as coronary thrombosis due to atherosclerotic plaque rupture, endothelial dysfunction, hypotension, and coronary embolism.
What is the best treatment for myocardial perfusion?
International guidelines recommend improving myocardial perfusion or decreasing the cardiac workload using a combination of therapies known as MONA: morphine, oxygen, nitrates, and aspirin. 1,2.
Can oxygen be given to patients with AMI?
Oxygen for AMI: Current Practice. Oxygen, via face mask or nasal cannula, is often administered to patients with suspected AMI in an attempt to increase myocardial oxygenation and decrease infarct size. 1.
Does oxygen help with AMI?
While treating AMI with oxygen makes sense from a physiologic standpoint, no studies have convincingly demonstrated that oxygen therapy improves outcomes in AMI. 1 In addition, recent data suggest that this practice may even be harmful.
Is oxygen therapy needed for myocardial infarction?
Evidence is lacking to support oxygen therapy for acute myocardial infarction. Coronary heart disease (CHD) remains a significant cause of death, accounting for 1 in 10 deaths worldwide and 1 in 7 deaths in the United States, even though medical advances have reduced mortality rates from CHD in developed nations.
Ritual and LP Headache
The practice of medicine is cloaked in ritual. Some rituals develop because their tenets seem reasonable. One such ritual is the belief that a variety of post-lumbar puncture practices will reduce the incidence and/or severity of post-LP headaches.
Support for NINDS
The three-hour time limit in which thrombolytic therapy can be administered for stroke doesn't allow many patients the opportunity to receive this therapy (which, depending on your point of view regarding the merits of this treatment, may be bad or good).
Police with AEDs Cut Defib Times
Many of us are of the “load-and-go” school when it comes to prehospital care, while others favor the “stay-and-play” position. In Los Angeles County where I practice, there is a hospital well within a 15-minute drive for 90 percent of the population. This is the ideal “load-and-go” city.
How effective is anti-VEGF treatment?
Anti-VEGF treatments are effective because they target one key factor that contributes to wet AMD: VEGF. But what if one drug could treat two underlying causes of AMD? That’s the idea behind the drug faricimab. It targets both VEGF and the protein angiopoietin-2. It’s injected into the eye like a standard anti-VEGF treatment, but it lasts a long longer. The latest research shows patients could go up to four months in between treatments. However, this data is so new that it has not yet been published in a peer-reviewed journal.
How often do you get AMD injections?
For more than a decade, ophthalmologists have treated wet age-related macular degeneration (AMD) with eye injections given every month or two, and dry AMD with antioxidant vitamins. These treatments were groundbreaking when introduced, offering hope for the first time that this sight-threatening disease could be slowed, ...
What is wet AMD?
New Treatments for Wet AMD. Wet AMD develops when new, abnormal blood vessels grow under the retina. These vessels may leak blood or other fluids, causing scarring of the macula. You lose vision faster with wet AMD than with dry AMD.
What is the complement cascade?
A part of the immune system called the “complement cascade” has long been identified as a culprit in AMD. Two new drugs that target the complement cascade and stop it from attacking the retina have recently advanced to late-stage clinical trials. One (pegcetacoplan, APL-2) targets a complement protein called C3, the other drug candidate ( Zimura, avacincaptad pegol) targets a different protein in the cascade, C5. Like currently available treatments for wet AMD, these drugs are injected directly into the patient’s eye. Already proven safe in people, researchers are now investigating whether they can substantially improve vision. Results are expected in about a year.
Does Beovu work for VEGF?
Novartis’ new drug, Beovu , is now approved for use in the United States.
Does Areds2 help with AMD?
For people with intermediate disease, a formulation of antioxidant vitamins called the AREDS2 formula can help reduce the risk of vision loss . But for people with late-stage AMD, also called geographic atrophy (GA), there is no treatment available. However, there are several promising clinical trials underway.
Can AMD be injected into the eye?
But they must be injected into the eye on a regular basis. "Today, more durable therapies are coming out, and treatments that may even cure the disease are in the works. There’s a lot of hope for people with AMD,” Sridhar says.
How often should I take amitriptyline?
Amitriptyline can be prescribed as a tablet or liquid. You’ll need to take it every day an hour or two before your usual bedtime, as it can make you sleepy. If you find you’re still feeling sleepy when you wake in the morning, try taking it earlier in the evening.
What is the purpose of amitriptyline?
Amitriptyline is a type of drug called a tricyclic antidepressant. These drugs were originally developed to treat anxiety and depression, but when taken at a low dose they can reduce or stop pain. Amitriptyline works by increasing the amount of serotonin your brain makes. Serotonin is a chemical, called a neurotransmitter, ...
Can you take amitriptyline with depression?
Amitriptyline is taken at lower doses for pain relief than when it's used for depression. Your doctor will usually start you on the lowest dose possible and may increase it if you're still experiencing pain after several weeks. Doses for children aged under 12 are worked out according to their weight and symptoms.
Can you take amitriptyline if you have fibromyalgia?
damage to nerve endings in limbs, which may be described to you as peripheral neuropathy (pe-rif-er-ul new-ro-pa-thee). You may not be able to take amitriptyline if: you’ve had an allergic reaction to a medication in the past.
