Myocardial Infarction (MI) aka Acute Myocardial Infarction (AMI) aka HEART ATTACK

Interruption of blood flow to the heart muscle that results in tissue necrosis Can be preceded by cardiac ischemia Can cause cardiac arrest. Medical Emergency! Admit to hospital.

Mallinson, T (2010). "Myocardial Infarction". Focus on First Aid (15): 15.

Hypotension Pale Skin Palpitations Sweating Chest pain SOB Nausea and Vomiting Lightheadedness Can proceed to LOC and sudden death.
Mallinson, T (2010). "Myocardial Infarction". Focus on First Aid (15): 15.

To save as much muscle as possible Prevent further complications

Eg CHF, arrhythmia, pericarditis.

Mallinson, T (2010). "Myocardial Infarction". Focus on First Aid (15): 15.

ABCs: assess and correct hemodynamic status first bed rest, cardiac monitoring, oxygen nitroglycerin SL followed by IV morphine IV Time is Muscle

ECG MI can have ST elevation (STEMI) or no ST Elevation (NSTEMI). Monitor ST segment continuously if patient is in pain. Cardiac Biomarkers CK MB, Troponins
Get Baseline bloods, including lipid profile.

Chest pain lasts more than 20 minutes Opiates more effective than sublingual GTN

Atypical symptoms like syncope and dyspnoea seen in the elderly and diabetic patients.
ST elevation seen on ECG
REF: Kumar and Clarks Clinical Medicine

Determine if the patient is at high risk of complications. Scoring systems include:

Thrombolysis In Myocardial Infarction (TIMI) score Global Registry of Acute Coronary Events (Grace)

REF: Kumar and Clarks Clinical Medicine

Low Risk patients Drugs alone Medium risk patients early coronary angiography + Drugs High Risk Patients urgent coronary angiography, refer for CABG.

Requires thrombolysis. NSTEMI does not. aspirin 150300 mg clopidogrel 300 mg

SL GTN 0.31 mg
oxygen nasal cannula 24 L/min (Fig. 15.21) H + E and risk calculation

Large bore IV access + blood for markers 12-lead ECG IV Opiate + antiemetic beta-blocker, if not contra-indicated.

Beta Blocker Clexane Morphine + Gravol Oxygen ASA Nitrates Statins ACEi
On call with Ward 9, SFGH.

Pt comes in with symptoms of ischemia Monitor to differentiate STEMI from NSTEMI

Thrombolysis is for STEMI only

Drugs used for MI include ASA, GTN, Morphine + gravol, O2 and beta blockers. High risk patients need angioplasty or CABG.

Mallinson, T (2010). "Myocardial Infarction". Focus on First Aid (15): 15. Kumar and Clarks Clinical Medicine, 8th Edition. Saunders Ltd. Davidsons Principles and Practice of Internal Medicine. http://www.timi.org/ Wikipedia Commons (image)