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.
- Quiet surroundings.
- 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.
- Bedside commode
- p Stool softener
- 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.
- 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
- 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.
- Anterior MI Previous infarction
- Severe depression of LV dysfunction.
- ACE-I is given within 24 hours of AMI specially with CHF.
- Continued indefinitely.