Overview of the non-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
Once the diagnosis of an acute ST elevation myocardial infarction (STEMI) is made, the early management of the patient involves the simultaneous achievement of several goals including 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 or fibrinolysis, and initiation of antithrombotic therapy. (See "Initial evaluation and management of suspected acute coronary syndrome (myocardial infarction, unstable angina) in the emergency department" and "Overview of the acute management of ST elevation myocardial infarction".)
These early diagnostic and therapeutic interventions are followed by the initiation of short- and long-term interventions aimed at improving in-hospital and long-term outcomes. This topic will summarize the management of patients with acute STEMI in the hours and days following the very early decision making period. (See "Overview of the acute management of ST elevation myocardial infarction".)
The management of the patient with a non-ST elevation or non-Q wave MI or with a complication of an acute MI (eg, cardiogenic shock, mitral regurgitation, ventricular septal defect) is discussed separately. (See "Overview of the acute management of unstable angina and non-ST elevation myocardial infarction" and "Prognosis and treatment of cardiogenic shock complicating acute myocardial infarction" and "Mechanical complications of acute myocardial infarction".)
FURTHER MEDICAL THERAPY
Aspirin and a platelet P2Y12 receptor blocker are usually given as soon as the diagnosis of acute ST elevation myocardial infarction (STEMI) is made. (See "Overview of the acute management of ST elevation myocardial infarction", section on 'Medications'.)
Early initiation of the following therapies may be of benefit in patients hospitalized with STEMI. Many of them are useful long term. (See 'Preparing for discharge' below.)
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- FURTHER MEDICAL THERAPY
- Oral beta blockers
- - Phosphodiesterase-5 inhibitors
- Statin therapy
- Calcium channel blockers
- In-hospital glycemic control
- Venous thromboembolism prophylaxis
- Red cell transfusion
- Gastrointestinal prophylaxis
- RECURRENT CHEST PAIN
- Recurrent ischemia and reinfarction
- - Diagnosis
- - Management
- Infarction pericarditis
- PREPARING FOR DISCHARGE
- Early discharge after an uncomplicated MI
- Risk stratification
- - Evaluation of LV function
- Stress testing
- Chronic anticoagulation
- Ventricular arrhythmias
- Return to activities
- DISCHARGE MEDICATIONS
- Antiplatelet drugs
- Angiotensin inhibition
- Mineralocorticoid receptor antagonists
- RISK FACTOR MODIFICATION
- Smoking cessation
- Long-term glycemic control
- Stress management
- Cardiac rehabilitation
- HEMATOPOIETIC STEM CELL THERAPY
- INFORMATION FOR PATIENTS