ST elevation myocardial infarction initial care

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Overview
The goal of initial care of the STEMI patient is to restore epicardial artery patency as rapidly and fully as possible, and to reduce the risk of early vessel reocclusion. Other goals include reducing the risk of lethal ventricular arrhythmias and other mechanical complications as well as reducing myocardial oxygen demands to limit infarct size with beta blockers.

Overview of Initial Therapies
Initial therapies include oxygen, aspirin, nitroglycerin or glyceryl trinitrate (an important exception is if the patient has a right ventricular myocardial infarction) and analgesia (usually morphine). Morphine is the preferred analgesic agent due to its ability to reduce adrenergic drive and reduce preload (it is a venodilator). NSAIDs and COX-2 inhibitors should be discontinued due to their association with higher rates of adverse events. The antiplatelet agent aspirin has been associated with a reduction in mortality and has limited adverse effects. Full dose non-enteric coated aspirin (162 mg to 325 mg) should be administered to a STEMI patient who does not have a history of hypersensitivity to ASA as soon as possible. In the absence of cardiogenic shock or heart failure, a beta blocker should also be administered.

Once the diagnosis of myocardial infarction is confirmed and diagnoses that would contraindicate the administration of antithrombins such as aortic dissection and pericarditis have been excluded, antithrombin therapy should be initiated.

Initial Care
You can read in greater detail about each of the therapies below in greater detail by clicking on the link for that therapy.

Oxygen | Nitrates | Analgesics | Aspirin | Beta Blockers | The coronary care unit | The step down unit