Guide to Manage Acute myocardial infarction

Guide to manage acute myocardial infarction


Taking the history of Acute Myocardial infarction Should be short and focused on the following

  • Description of chest pain or chest discomfort and associated symptom to differentiate cardiac from non-cardiac
  • History of DM, HTN
  • Prior history of coronary ischemia or MI
  • Neurologic symptom
  • Ask about risk factor for bleeding

Physical Exam

  • ABC and Vital sign, pulse
  • JVD
  • CHF Pulmonary edema
  • Murmur, or gallops

The most important finding is the elevation of the ST segment on EKG



  • Aspirin
  • Clopidogrel if Aspirin is contraindicated
  • Sublingual or IV Nitroglycerin
  • Oxygen
  • Morphine
  • Admit to Critical Care Unit and cardiology consult
  • PCI within 90 min if available
  • Thrombolytic if PCI is not available, should be done within 12 hours
  • Do not transfer to perform PCI, use Thrombolytic
  • Metoprolol or Atenolol
  • ACE inhibitors with EF < 40%

If PCI available in less than 90 min do it, else use fibrinolytic within 30 min

Fibrinolytic Therapy

Use of fibrinolytic therapy within the 1st five hours of STEMI decrease mortality
Don’t use if there is a risk of bleeding

Fibrinolytic agent

  • Alteplase
  • Reteplase, Bolus administration 10U + 10U
  • Tenecteplase, Bolus administration 0.5 mg/kg

PCI percutaneous coronary intervention

Use it if there is a contraindication to fibrinolytic

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