Acute Myocardial Infarction in patients presenting with ST-segment elevation (Management of)

Topics: Acute Coronary Syndromes (ACS)

Authors

Table of contents: Full Text (ESC Clinical Practice Guidelines)

Introduction

The definition of acute myocardial infarction, The pathogenesis of ST-segment elevation acute myocardial infarction, The natural history of STEMI

First medical contact and emergency care flow

Initial diagnosis and early risk stratification, Relief of pain, breathlessness, and anxiety, Cardiac arrest

Pre-hospital or early in-hospital care

• Restoring coronary flow and myocardial tissue reperfusion:
  • Percutaneous coronary interventions, Fibrinolytic treatment, Antithrombotic therapy without reperfusion therapy, Prevention and treatment of microvascular obstruction and reperfusion injury, Coronary bypass surgery

• Pump failure and shock:
  • Clinical features, Mild heart failure (Killip class II), Severe heart failure and shock (Killip class III and IV)

• Mechanical complications:
  • Cardiac rupture and mitral regurgitation, Cardiac rupture, Mitral regurgitation

• Arrhythmias and conduction disturbances in the acute phase:
  • Ventricular arrhythmias, Supraventricular arrhythmias, Sinus bradycardia and heart block

• Routine prophylactic therapies in the acute phase:
  • Antithrombotic agents: aspirin, clopidogrel, and antithrombins, Antiarrhythmic drugs, b-Blockers, Nitrates, Calcium antagonists, Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, Magnesium, Glucose–insulin–potassium

• Management of specific types of infarction:
  • Right ventricular infarction, Myocardial infarction in diabetic patients, Patients with renal dysfunction

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

• Indications and timing, Assessment of myocardial viability, Evaluation of risk of arrhythmia for prevention of sudden death

Rehabilitation and pre-discharge advice

• Psychological and socio-economic aspects, Lifestyle advice, Physical activity

Secondary prevention

• Smoking cessation, Diet, dietary supplements, and weight control, Physical activity, Antiplatelet and anticoagulant treatment, b-Blockers, Calcium antagonists, Nitrates, Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, Aldosterone blockade, Blood pressure control, Management of diabetes, Interventions on lipid profile, Influenza vaccination, Cardiac resynchronization therapy, Prophylactic implantation of an implantable cardioverter–defibrillator

Logistics of care

• Pre-hospital care
  • Patient delay, Emergency medical system, Public education in cardiopulmonary resuscitation, The ambulance service, Networks, General practitioners, Admission procedures

• The Intensive Cardiac Care Unit:
  • Non-invasive monitoring, Invasive monitoring

• The post-discharge period

Gaps in evidence