Acute Myocardial Infarction, AMI

Notes
  • Commonly referred to as heart attack, it is the irreversible necrosis of myocardium due to a long duration of ischemia (inadequate blood supply to a tissue, mainly the cardiac muscles).
  • Ischemia results from partial or complete coronary occlusion that can be caused by: a thrombus that is superimposed on an ulcerated or unstable atherosclerotic plaque, atherosclerosis, coronary vasospasm and elevated myocardial metabolic demand e.g. in excessive physical exertion, severe hypertension and valvular pathologies among others.
  • The risk factors for AMI include: hyperlipidemia; diabetes mellitus; hypertension; tobacco use; male gender and family history
Symptoms
  • Sudden death with no other symptoms
  • Fainting
  • Sweating
  • Arrhythmias
  • Pulmonary edema
  • It occurs mostly in early morning hrs
  • Chest pain in the mid portion of the thorax that might be referred to the jaw or teeth, shoulder, arm, and back
  • Dyspnea
  • Pallor
  • Hypotension
  • Epigastric discomfort
  • Impairment of cognitive function without other cause
Diagnosis
  • ECG
  • Creatine kinase (CK), troponin I and T, myoglobin (that are released by dead myocardial cells)
  • Echocardiogram
  • Nuclear imaging
Differential
  • Acute cholecystitis
  • Acute Mitral Regurgitation
  • Anxiety Disorders
  • Aortic dissection
  • Asthma
  • Cardiogenic Shock
  • Esophageal rupture
  • Gastroesophageal reflux
  • Myocarditis
  • Myopericarditis
  • Peptic ulcer disease
  • Pericardial effusion causing cardiac tamponade
  • Pneumonia
  • Pulmonary embolism
  • Stable ischaemic heart disease
  • Tension pneumothorax
  • Tietze's syndrome (Costochondritis)
Prevention

Prevention of Recurrences of Myocardial Infarction

  • Pharmacological measures: aspirin, beta blockers, statins and ACE inhibitors
  • Effective control hypertension
  • Diet
  • Smoking cessation
  • Physical exercises

 

Management
  • Cardio-pulmonary resuscitation (CPR)
  • Oxygen (100%) for 2-6hrs

(or longer)

  • Maintenance of vital functions
  • To arrest further damages;

*Sublinqual tabs Glycerine trinitrate  0.5mg  every 5-10 minutes (Max. 5 tabs) + Tabs Aspirin 150mg OD indefinitely 

(Tabs clopidogrel  75mg daily may be use with aspirin for a month)

  • For analgesia;

Either;

*IM or IV Pethidine 50-100mg

Or;

 *IM or IV Morphine 10-15mg at a rate of 1mg /Min

  • Thrombolysis
  • Angioplasty
  • Defibrillation in case of ventricular fibrillation
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