Question

Myocardial Infarction Management (STEMI and NON-STEMI)

Include all you can about this management.

Please include references if any. Thank you

Answer 1

• Myocardial Infarction (MI) : Blockage of blood flow to the heart muscles.

1. ST Elevation MI (STEMI) : cause due to formation of an conclusive thrombus at the site of rupture of an atheromatous plaque.
2. Non ST Elevation MI (NSTEMI) : Caused by imbalance between oxygen supply and oxygen demand due to partially occluding thrombus.

• Management of MI :

1. ​​​​​Immediate management : first 24-48 hours risk for fatal arrhythmia is high, so patients should be treated in intensive coronary care unit.
2. Initial treatment :

• ​​​
• Morphine : to control chest pain
• Oxygen 4L / min : to patients with SO2<90%
• Nitroglycerin
• Aspirin 325 mg

3. Confirm the diagnosis by ECG and cardiac biomarkers( troponin T, I and CK-MB)

4. Analgesics for pain control

5. Beta blockers if not contraindicated

6. Anti thrombotic therapy :

• Anti platelet therapy :

1. Aspirin
2. Aspirin + ADP receptor blocker ( clopidogrel)
3. Glycoprotein 2b/ 3a receptor antagonist ( abciximab)

• Anticoagulants : for patients who do not receive fibrinolytic agents

1. Unfractioned heparin
2. Low molecular weight heparin
3. Direct thrombin inhibitors

• High dose statins to all patients

7. Management of complications such as arrhythmia, congestive failure, shock pericarditis etc.

8. After treatment recommendations :

• Physical exercise : control of obesity by regular exercise
• Life style modifications : cessation of smoking, decrease lipid intake in diet etc.