Treatment for myocardial infarction involves several steps: 1. Anti-platelet agents like aspirin and clopidogrel are given to prevent blood clot formation and recurrence. 2. Reperfusion therapy uses thrombolytic drugs like streptokinase, alteplase, and tenecteplase to break up blood clots. 3. Other drugs are given to reduce blood pressure and heart strain, such as nitrates, beta blockers, and ACE inhibitors. Analgesics and anti-anxiety drugs provide pain relief. Anticoagulants like heparin prevent further clotting.

1. Treatment
Of
Myocardial
Infarction
SUDIR VIGNESHWAR
1st Year M.B.B.S

5. Anti- platelet agents
ASPIRIN
Orally
162-325 mg
CLOPIDOGREL (If allergic to aspirin)
Orally
75 mg
Should be continued once everyday.
Whether or not 'thrombolytic therapy' is instituted.
Prevents the formation and the recurrence of a blood clot over the plaque.

6. Reperfusion therapy via drugs
▪ THROMBOLYTIC THERAPY
Six enzymes are used:
Streptokinase: non-specific, least effective, allergic reactions
Anistreplase: similar to streptokinase, allergy, hypotension
Alteplase: recombinant DNA technique, specific, shorter half-life, early reocclusion
Reteplase: recombinanat DNA technique, longer half-life
Tenecteplase: longer half-life, increased fibrin senstivity
Urokinase: cheaper, non-antigenic, non-hypotensive, activates plasminogen directly

7. Nitrates
▪ NITROGLYCERIN (GTN)
Intravenous
Vasodilator
Lowers B.P.
Early infusion reduces infarct size and mortality
Treats left ventricular failure
Prevents recurrent ischaemia
Sodium Nitroprusside
Vasodilator
Cyanide poisoning

8. Beta-Blockers
▪ METOPROLOL, PROPRANOLOL , ATENOLOL
Intravenous 5 mg every 5 minutes for 3 doses
Administered during the first 24 hours at least for 2 years
Reduces infarct size
Prevents reinfarction
Reduces duration of ischaemia
Decreases incidence of ventricular fibrillation
Cuts down mortality rate
Contraindicated for those with HR less than 50 beats per minute, systolic BP below 100 mmHg, asthma, CHF, AV Block

9. Angiotensin Converting Enzyme Inhibitor (ACEI)
▪ Lisinopril, Ramipril
Prevent re-modelling of the heart
Reduce chance of subsequent CHF

10. Analgesics & Anti-anxiety drugs
▪ Nitrates
Sublingual/Intravenous relieves coronary artery spasm with restoration of coronary blood
Flow
Morphine
4-8 mg, intravenously, with antiemetic like promethazine 25-50 mg to prevent vomiting
Pethidine
50-60 mg, intravenously, with antiemetic
Diazepam/Alprazolam
Anti-Anxiety Drugs

11. Anti- coagulants
▪ Heparin
▪ Orally
▪ Prevents thrombus extension, embolism, venous thrombosis
▪ Dalteparin/Enoxaparin
▪ Low molecular weight heparin
▪ Less expensive

12. Statins & Bicarbonates
▪ Atorvastatin
Controls Hyperlipidaemia
Reduces thrombotic events and reinfarction
Sodium Bicarbonate
Neutralizes the lactic acid
Used to treat acidosis