by Dr. Lailmaah Habibi 2017

1. Management of acute MI
Dr. Lailmaah Habibi 3rd year trainee of KABUL RBH ( afg), 2017

2.  Aspirin :all pts definite or suspected MI
 𝑝2 𝑦12 inhibitors: in combine with aspirin, ‘v shown ↑ important benefits in
acute STEMI
 Preferred 𝑝2 𝑦12I : prasugrel & ticagrelor

3. 1) Primary PCI
2) Fibrinolytic thX
Drug eluting
stents

4. a)_PCI stenting is standard for AMI
I. DES
II. BMS
b)_ antiplatelet therapy after drug-eluting / bare metal stents
 DAPT is indicated for 1yr in all pts (medical thX & pts undergoing
revascularization irrespective of stent type

5.  Alteplase (rt_PA)
 Reteplase (r_PA)
 Tenecteplase (TNK_PA)
 Streptokinase (SK)

6.  Selection of a fibrinolytic agent :
 differences in efficacy between them are small
 principal objective is to administer a thrombolytic agent within
30 min of presentation or even during transport.

7.  aspirin
 Anticoagulation: continued until revascularization / duration of hospital stay or
(up to 8 days) .
 LMWH (enoxaparin or fondaparinux) is prefered to UFH
 (A) LMWH
 (B) UFH
 (c) Prophylactic Therapy Against Gastrointestinal Bleeding

8.  Initial attempt should be made to relieve pain vs sublingual NTG
 IV opioids provide most rapid & effective analgesia also ↓pulmonary
congestion.
 Morphine sulfate4-8 mg / meperidine 50-75 mg .

9.  The benefits in STEMI pts divided into: those occur immediately when the drug
is given acutely /over the long term after infarction.
 metoprolol 25-50 mg orally BID
 Carvedilol 6.25 mg BID , titrated to 25 mg BID

10.  NTG is the agent of choice for continued or recurrent ischemic pain
↓Bp & ↓ pulmonary congestion
 routine nitrate administration not recommended

11.  short- and long-term survival improvement vs ACE inhibitor therapy.
 Because substantial amounts of the survival benefit occur on the 1ST day, ACE
inhibitor Tx should commenced early in pts without hypotension, especially
with large / Ant _MI

12.  patients with ACE inhibitor intolerance
 valsartan 160 mg orally BID is equivalent to captopril in ↓ mortality
& ↑ expensive alternative to captopril.

13.  ↓ Mortality rate of pts with advanced HF
 Spironolactone 25mg/d
 Eplerenone 25 mg /d

14.  All pts in the abcense of CI should receive statins
 Goal LDL < 70mg/dl or 70% ↓ in LDL level

15.  No studies to support the routine use of CCBs
 Long- acting CCBs should generally be reserved for management of HTN
& ischemia as 2nd & 3rd line medications after beta-blockers and
nitrates.

16.  Smoking Cessation and lifestyle modifications.
 Aspirin, Beta Blockers and Clopidogrel will be indefinite.
 Lipid lowering medication along with diet modifications

17.  Source:
 CMDT 2017
 HARRISSON TEXTBOOK EDITION 19TH
 WASHINGTON MANUAL 35TH EDITION