The Management of Patients with Acute Myocardial Infarction

Posted by e-Medical PPT Saturday, September 1, 2012
Differential Diagnosis of Prolonged Chest Pain
AMI
Aortic dissection
Pericarditis
Atypical angina pain associate with hypertrophic cardiomyopathy
Esophageal, other upper gastrointestinal, or biliary tract disease
Pulmonary disease
  pneumothorax
  embolus with or without infarction
  pleurisy: infectious, malignant, or immune disease-related
  Hyperventilation syndrome
Chest wall
  skeletal
  neuropathic
Psychogenic

Patient with Acute Chest Pain with T-wave inversion or ST depression
Differential diagnosis
ischemia
acute posterior MI
ventricular hypertrophy
digoxin effect
pericarditis
pulmonary embolus
LBBB
hyperventilation
anxiety
normal variants

Serum Cardiac Markers
CK-MB subfomes for Dx within 6 hrs of MI onset
cTnI and cTnT efficient for late Dx of MI
CK-MB subform plus cardiac-specific troponin best combination
Do not rely solely on troponins because they remain elevated for 7-14 days and compromise ability to diagnose recurrent infarction

Enzymatic Criteria for Diagnosis of Myocardial Infarction
Serial increase, then decrease of plasma CK-MB, with a change > 25% between any two values
CK-MB > 10-13 U/L or > 5% total CK activity
increasing MB-CK activity > 50% between any two samples, separated by at least 4 hrs
if only a single sample available, CK-MB elevation > twofold
beyond 72 hrs, an elevation of troponin T or I or LDH-1 > LDH-2

Initial Management
ContraindicatIons and Cautions for Fibrinolytic Used in Myocardial Infarction
Absolute Contraindications:
Previous hemorrhagic stroke at any time: other strokes or cerebrovascular events within one year
Known intracranial neoplasm
Active internal bleeding (does not include menses)
Suspect aortic dissection
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