Acute myocardial infarction

Pathophysiology

Abrupt decrease in coronary blood flow following a thrombotic occlusion of a coronary artery previously narrowed by atherosclerosis.

Treatment

At presentation:
  1. Introduce, explain, re-assure
  2. Sit up
  3. Give high flow O2 (unless contraindicated)
  4. ECG monitor
  5. Aspirin 300 mg chewed (if GP not already given)
  6. IV access
  7. Blood tests (cardiac enzymes, FBC, U&E)
  8. Morphine (anxiolytic, venodilator) + metoclopramide
  9. Nitrates sublingual or IV (venodilator)
  10. β-blocker (e.g., metopralol)
  11. Thrombolysis if indicated (characteristic pain, ST ↑ or new BBB)
  12. Arrange transfer to CCU
Day 2:
  1. ACE inhibitor
  2. Heparin IV