Management of Acute Chest Pain / Myocardial Infarct



- See: blunt cardiac trauma

- Initial Management:
    - determine whether the chest pain is of cardiac origin:
          - sublingual nitroglycerin should improve chest pain (at least partial relief) if the pain is of cardiac origin;
          - EKG changes in MI:
          - labs: CBC, cardiac enzymes (CPK q6 hours x 4 or cardiac troponin T & I);
    - optimize cardiovascular function:
          - nitrates can be given sublingually or topically before intravenous access is obtained;
          - arrhythmia
          - hypertension:
                 - elevation of blood pressure should be managed with combination of nitrates, beta blockers (antihypertensive agents), and morphine;
                 - nitrates are the treatment of choice in patients who have hypertension with angina or myocardial infarction;
                 - beta-blocker therapy given IV at admission, reduces mortality & infarct size and is recommended;
                 - IV labetalol and calcium-channel antagonists also reduce blood pressure while improving myocardial oxygenation.
          - hypoxia: w/ decrease O2 sats, order ABG, and give O2;
          - anemia: pRBC transfusion
    - monitoring: patient should be placed on a telemetry bed if one is available;
    - blood thinners and thrombolytics:
          - begin thrombolytic therapy in combination with aspirin and heparin;

- Sequelae of MI:



- Outside Links:
    - GMO Manual
    - GMO Manual
    - Iowa Family Practice Handbook - 1
    - Iowa Family Practice Handbook - 2
    - Merck Manual
    - GMO Manual
    - Iowa Family Practice Handbook - 1
    - Iowa Family Practice Handbook - 2
    - Merck Manual



- References:



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, June 9, 2011 1:48 pm