Overview of the acute management of ST elevation myocardial infarction
- Guy S Reeder, MD
Guy S Reeder, MD
- Section Editor — Coronary Disease
- Professor of Medicine
- Mayo Medical School
- Harold L Kennedy, MD, MPH
Harold L Kennedy, MD, MPH
- Adjunctive Professor of Medicine and Cardiovascular Diseases
- University of Missouri School of Medicine
- Section Editors
- Christopher P Cannon, MD
Christopher P Cannon, MD
- Section Editor — Coronary Heart Disease
- Professor of Medicine
- Harvard Medical School
- James Hoekstra, MD
James Hoekstra, MD
- Section Editor — Adult Cardiology Emergencies
- Professor and Fredrick Glass Chair
- Wake Forest University
The first step in the management of the patient with an acute ST elevation myocardial infarction (STEMI) is prompt recognition, since the beneficial effects of therapy with reperfusion are greatest when performed soon after presentation. For patients presenting to the emergency department with chest pain suspicious for an acute coronary syndrome, the diagnosis of STEMI can be confirmed by the electrocardiogram. Biomarkers may be normal early. (See "Criteria for the diagnosis of acute myocardial infarction" and "Initial evaluation and management of suspected acute coronary syndrome (myocardial infarction, unstable angina) in the emergency department".)
Once the diagnosis of an acute STEMI is made, the early management of the patient involves the simultaneous achievement of several goals:
●Relief of ischemic pain
●Assessment of the hemodynamic state and correction of abnormalities that are present
●Initiation of reperfusion therapy with primary percutaneous coronary intervention (PCI) or fibrinolysis
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- STEMI AFTER NONCARDIAC HOSPITAL ADMISSION
- GENERAL PRINCIPLES
- Elderly patients
- Cocaine associated MI
- Possible stent thrombosis
- INITIAL ASSESSMENT
- Acute triage
- Early risk stratification
- INITIAL THERAPY
- - Percutaneous coronary intervention
- - Fibrinolysis
- - Angiography after fibrinolysis
- - Bypass surgery
- - Antiplatelet therapy
- - Anticoagulant therapy
- - Nitrates
- - Morphine
- - Beta blockers
- - Statin therapy
- - Arrhythmia prevention and management
- - Nonsteroidal anti-inflammatory drugs
- - Potassium and magnesium
- - Erythropoietin
- - Intravenous glucose-insulin-potassium
- MI WITH NORMAL CORONARY ARTERIES