– History –
- Typical chest pain:
- Substernal
- Min-hrs
- Radiation to upper limbs, shoulders, neck, jaw
- Pressure\dull\heaviness\tightness in nature
- Relieved by rest or NTG
- Not pleuritic, positional, reproducible
- Associated w\ nausea, diaphoresis, palpitations
– Initial Management –
- ABCs!
- Obtain 12-lead ECG
- Place the pt in a monitored bed + keep on bed rest
- Establish IV access
- Activate cath lab
- Arrange admission to CCU
- Keep pt NPO
– Investigations –
- ECG
- Labs:
- Cardiac enzymes
- CBC
- Coagulation profile
- Chemistry (electrolytes, baseline liver and renal function)
- Angiography
– Treatment –
- O2
- NTG (3 sublingual tablets of 0.4 mg one at a time, spaced 5 mins. Or spray. IV if persistent)
- Don’t use w\ inferior MI -> severe hypotension
- Morphine (2-4 mg IV)
- Aspirin (300-350 mg, non-enteric coated, chewed and swallowed)
- B-blockers (2.5 mg IV metoprolol. Alternatives: carvedilol, bisoprolol)
- Statin (80 mg of atorvastatin) -> (time doesn’t matter, as long as w\in admission)
- Clopidogrel (600 mg)
- GpIIb\IIIa inhibitors (only given if the pt will undergo PCI, or has NSTEMI)
- LMWHeparin (IV) -> (if STEMI -> give after tPA, if NSTEMI -> give immediately)
- tPA? (if PPCI not available w\in 3 hrs, onset < 12 hrs, and no contraindications) -> only given in STEMI
- Primary PCI (immediately in STEMI, in NSTEMI if medical tx failed)
– Post MI –
- Monitor for complications (esp arrhythmia)
- Do echo to check LV function
- Keep on aspirin, B blockers, statins
- Give ACEI (esp if systolic dysfunx)
- Lifestyle modifications; HTN, DM, DLP, diet, exercise, smoking, stress
