COMPLETE MANAGEMENT OF AMI Coronary Care Unit (CCU)

COMPLETE MANAGEMENT OF AMI Coronary Care Unit (CCU)

  • Patients of AMI are admitted to CCU for monitoring of all vital parameters, management of arrhythmias,
  • thrombolytic therapy.

For more  management-of-acute-myocardial-infarction-ami and  acute-myocardial-infarction-management-regime-for-management-of-ami

Sedation

  • DiazeRam
  • Lorazepam
  • Reassurance
  • Quiet surroundings.

Diet

  • Liquids for 1St 12 hours.
  • Fat <30 % of total calories, carbohydrate – 50% of total calories, cholesterol <300 mg/day.
  • Small frequent foods with potassium, magne­sium, fibre, vitamins.
  • Low sodium.
  • Avoid sweets.
  • Bowels
  • Bedside commode
  • p Stool softener
  • Laxative.

AMI Coronary Care Unit (CCU)

COMPLETE MANAGEMENT OF AMI Coronary Care Unit (CCU)

Activity
  • Bed rest for 12 hours.
  • Then dangling the legs on the side of the bed, sitting up in a chair – in 24 hrs – this reduces pulmonary capillary wedge pressure.
  • On 3rd day patients can take bath.
  • Thereafter patients can start walking few paces.

 

Anti-thrombotic agents

  • Aspirin.
  • GP lIb I IlIa antagonist.
  • UFH – Unfractionated heparin helps to maintain patency of infarct related artery.
  • (Low molecular weight heparins LMW ) may be used instead of UFH as it has advantages:
  • Is given subcutaneously
  • Stable anticoagulant effect Prevent thromboembolization.
  • Clopidogrel – A combination of clopidogrel + As­pirin is -superior to Aspirin alone to prevent IHD.
  • Anyone or more, even upto four of the above can be given together.

 

Indications of LMW

   

  • LV dysfunction
  • Anterior MI
  • CHF
  • H/O embolism
  • Mural thrombous
  • Atria fibrillation.

 

Beta Adrenoceptor Blockers:

  • IV blockers are given to : Relieve pain Prevent arrhythmias. Decrease oxygen demand Decrease ischemia Decrease mortality Metoprolol is given 5mg every 5 min 3 times. Then 50mg is given ever 6 hours for 48 hours. Then 100mg every 12 hours.

 

Angiotensin converting enzyme inhibitors (ACEI)

  • Reduces the mortality of AMI.
  • It prevents ventricu­far remodelling after infarction.
  • Prevent rcecurrent infarction.

 

Special indications:

  • Elderly
  • Anterior MI Previous infarction
  • Severe depression of LV dysfunction.
  • ACE-I is given within 24 hours of AMI specially with CHF.
  • Continued indefinitely.
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