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.

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Sedation

• DiazeRam
• Lorazepam
• Reassurance
• Quiet surroundings.

Diet

• Liquids for 1S^t 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.

COMPLETE MANAGEMENT OF AMI Coronary Care Unit (CCU)

• 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 3^rd 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.