MANAGEMENT of Acute Myocardial Infarction (AMI)

MANAGEMENT Management involves

• Prompt attention and diagnosis.
• Reperfusion therapy
• Management of pain.

MI is a medical emergency; Typical treatment for the patient includes:

• diagnosis and treatment should not be delayed.
• administering oxygen immediately, and giving aspirin and beta blockers, unless there are strong contraindications.
• ordering fibrinolytic drugs (e.g., tissue plasminogen activator) unless contraindicated or emergency angioplasty (where it is available).
• giving angiotensin converting enzyme inhibitors.
• giving statins.
• giving nitrates and morphine for vasodilation and pain relief. giving antiplatelet agents such as heparins or glycoprotein IIb/IIIa inhibitors.

Management of Pain

Morphine :

• For pain Morphine is given to :
  • Decrease sympathetic drive
  • Decrease cardiac output
  • Decrease arterial pressure
  • Decrease cardiac work load
  • Decrease vasoconstriction
  • Symptomatic relief.

Side effects of Morphine ..

• Severe hypotension – elevate legs and give IV saline
• Bradycardia – give atropine IV
• Heart block – give atropine 0.5 mg IV – repeat if
• necessary
• Diaphoresis and Nausea
• Vomiting – give antiemetics.
• Dose
  • Injection Morphine is given- 2 to 5 mg IV at a time. –

Nitroglycerine:

• Sublingual NTG is given 0.4 mg sublingual at 5 minute intervals. –

Nitrate :

• are given to decrease myocardial oxygen ?emand, a*nd increase myocardial oxygen supply.
• IV NTG is given if BP is more than 100 mmHg . Not to be given in RV infarction.

Beta 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.

Contraindications of Beta Blocker —

• Heart rate <60 per minute
• Systolic blood pressure < 100 mmHg
• PR Interval >0.24 sees.
• Rales > 10 em above the diaphragm

Calcium Channel blockers

• have little role. It raises the threshold for angina.
• read more about management AMI —

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