Management of Myocardial infarction is a medical emergency. If you have symptoms of a heart attack seek immediate medical attention. Never try to drive your self to the hospital and do not waste time. In a hospital there will be a battery of tests, which would help you make a diagnosis of myocardial infarction.
Investigations Done
- Electrocardiography: easily available and non invasive technique, most commonly used in most health care setups.
- Cardiac Markers: laboratory evidence for cardiac muscle damage such as Troponin T and I, Creatinine phosphokinase (CPK), Lactate dehydrogenase (LDH).
- Coronary angiogram: allows visualization of narrowing or obstructions on the heart vessels, and consequent interventions.
- Chest X-rays
- Echocardiography
- MRI and CT imaging
These investigations combined with clinical findings by a consultant can diagnose a case of myocardial infarction. Management of heart attack should start at moment the patient experiences symptoms. Pain to needle time can be minimized to a great extend by timely intervention in part of the public and health care staff.
First aid
Myocardial infarction is a common condition encountered in the society. The knowledge of the first aid principle can save lives. The emergency action principles also apply in the case of myocardial infarction. Calling for help is the important first step. Make necessary provision to move the patient to a well equipped heath care set up. A half-sitting position with knees bent is often recommended. Access to more oxygen can be given by opening the window and widening the collar for easier breathing. Aspirin can be given quickly, and can be asked to chew, rather than swallow. Glyceryl trinitrate can be used under tongue, if available.
At Hospital – The Reperfusion Era
Immediate steps are taken in a direction to alleviate pain. Morphine is the commonly used drug. Immediate steps should be made to reperfuse (re-establish the circulation) the affected area. The concept of reperfusion has become so central to the modern treatment of acute myocardial infarction. The available options are:
- Thrombolytic therapy – using medical intervention such as Streptokinase or Alteplase the formed clot can be lysed and the blood supply to the area secured.
- Percutaneous coronary intervention (PCI) – a guide wire is passed through an artery in the thigh and a balloon is inflated at the site of the obstruction, relieving the same.
- Coronary artery Bypass Graft
Follow up and prevention of a further episode
Careful monitoring and evaluation of the patient is the corner stone of post reperfusion management. He should be carefully mobilized and should be put on medications to control the risk factors. Prevention of myocardial infarction involves:
- Strict blood sugar control
- Strict blood pressure control
- Cessation of tobacco smoking
- Limitation of alcohol consumption
- Life style change with routine exercises
- Sensible diet
