B. Percutaneous intervention (PCI) – Explanation
Not all myocardial infarction presents with the typical cardiac chest pain symptoms. Some may present
with atypical chest pain which can be described as an ache or discomfort. Other atypical symptoms
include abdominal discomfort or epigastric pain.
As there is ST elevation in leads I, II and aVF, this confirms the diagnosis of a myocardial infarction.
Percutaneous intervention (PCI) would be the best management for myocardial infarction
POST MANAGEMENT OF HEART FAILURE AND MYOCARDIAL INFARCTION (MI)
| Heart Failure | MI |
| Row Decrease mortality 1. ACE inhibitor (Enalapril, Lisinopril, Ramipril) 2. Beta blocker (Bisoprolol, Carvedilol, Nebivolol)(Initiate one at a time)Manage symptoms FurosemideAdd on if symptoms are not controlled: Spironolactone, or Digoxin2 |
ALL pts with MI on discharge:
|
Myocardial infarction management is tricky and it is always changing.
A good way to remember the first few steps of managing myocardial infarction is to remember the
mnemonic MONA=Morphine, O2, Nitrates, Aspirin 300 mg
Morphine is given intravenously to manage the pain.
Oxygen is administered if there is evidence of hypoxia, pulmonary oedema, or continuing myocardial
ischaemia.
Nitrates such as GTN sublingual or by intravenous infusion is used to treat angina.
Aspirin 300 mg should be given preferably before arrival to hospital. Clopidogrel 300 mg should also be
given.
Heparin (unfractionated) or a low molecular weight heparin (e.g. enoxaparin sodium) should also be
considered.
For STEMIs, current recommendations are to revascularize with percutaneous coronary intervention
(PCI) if within 12 hours of onset of symptoms and if PCI can be delivered within 120 minutes of the time
when fibrinolysis could have been given.
Many hospitals have 24-hour PCI capacity. Ambulances who pick up patients with ST elevations are
usually directed to hospitals with such facilities however in the event the ST elevation is only picked up
after the patient arrives to a hospital without catheterisation laboratories, the patient would be transferred
out to another hospital with PCI facilities usually within 30 minutes of presentation.
STEMI management summary
- If patient presents to hospital with symptom onset within 12 hours AND PCI can be delivered within
120 minutes of the time when fibrinolysis could have been given – perform PCI - If PCI not available and cannot be delivered within 120 minutes of time when fibrinolysis could have
been given – Thrombolysis (Alteplase)
- Thrombolysis can only be done within 12 hours of symptom onset
