Treatment of myocardial infarction

There are many treatments for myocardial infarction. Although there are many treatments for myocardial infarction on the market, general conventional treatments have little effect on the treatment of myocardial infarction. Therefore, many people will slowly look for some treatments that suit them after suffering myocardial infarction. Myocardial infarction is a common disease among us, and for people who suffer from myocardial infarction, the pain it brings is very great.

Myocardial infarction is a disease that is very harmful to the human body, which people who have suffered from myocardial infarction generally know. Moreover, when a person with myocardial infarction suffers an attack, the pain they experience is very great, or even extreme. So, in response to this situation, let’s talk about the treatment of myocardial infarction.

Myocardial infarction is myocardial necrosis caused by acute and persistent ischemia and hypoxia of the coronary arteries. Clinically, there is often severe and persistent pain behind the sternum, which cannot be completely relieved by rest or nitrates, accompanied by increased serum myocardial enzyme activity and progressive electrocardiogram changes. It may be complicated by arrhythmia, shock or heart failure, which is often life-threatening. This disease is most common in Europe and the United States, with approximately 1.5 million people suffering from myocardial infarction each year in the United States. China has shown a clear upward trend in recent years, with at least 500,000 new cases each year and at least 2 million current patients.

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Myocardial infarction occurs suddenly and should be detected and treated early, with strengthened pre-hospitalization treatment. The principles of treatment are to save the dying myocardium, reduce the area of ​​infarction, protect heart function, and deal with various complications in a timely manner.

1. Monitoring and general treatment

Patients without complications should stay in bed for 1 to 3 days during the acute phase; receive oxygen; and undergo continuous ECG monitoring to observe changes in heart rate, heart rhythm, blood pressure, and respiration. For patients with hypotension or shock, monitor capillary wedge pressure and venous pressure when necessary. Low salt, low fat, eat small meals frequently, and keep bowel movements regular. After 3 days, patients without complications gradually transitioned to sitting in a chair next to the bed to eat, urinate, and move around indoors. Patients can usually be discharged from the hospital within 2 weeks. For patients with heart failure, severe arrhythmias, hypotension, etc., the bed rest time and discharge time need to be extended as appropriate.

2. Sedation and pain relief

Small doses of intravenous morphine are the most effective analgesic; pethidine can also be used. Those who are irritable and nervous can be given diazepam (Valium) orally.

3. Adjust blood volume

Establish intravenous access as soon as possible after admission, and slowly replenish fluids in the first 3 days, paying attention to the balance of intake and output.

4. Reperfusion therapy to reduce infarct area

Reperfusion therapy is the main treatment measure for acute ST-segment elevation myocardial infarction. Opening the blocked coronary artery and restoring blood flow within 12 hours of onset can reduce the area of ​​myocardial infarction and reduce mortality. The earlier the coronary artery is reopened, the greater the benefit to the patient. "Time is myocardium, time is life." Therefore, a diagnosis must be made as soon as possible for all patients with acute ST-segment elevation myocardial infarction, and a reperfusion therapy strategy must be developed as soon as possible.

(1) Primary coronary intervention (PCI)

In hospitals with emergency PCI conditions, if the first balloon dilatation can be completed within 90 minutes of the patient's arrival at the hospital, all patients with acute ST-segment elevation myocardial infarction within 12 hours of onset should undergo direct PCI treatment, with balloon dilatation to reopen the coronary artery and stent placement if necessary. In the acute phase, only the infarct-related artery is treated. Patients with cardiogenic shock should be treated with direct PCI regardless of the onset of the disease. Therefore, patients with acute ST-segment elevation myocardial infarction should seek treatment in a hospital with PCI facilities as much as possible.

(2) Thrombolytic therapy

If there are no conditions for emergency PCT treatment, or the first balloon dilatation cannot be completed within 90 minutes, thrombolytic therapy should be performed on patients with acute ST-segment elevation myocardial infarction within 12 hours of onset if the patient has no contraindications to thrombolytic therapy. Commonly used thrombolytic agents include urokinase, streptokinase and recombinant tissue plasminogen activator (rt-PA), which are administered by intravenous injection. The main complication of thrombolytic therapy is bleeding, the most serious of which is cerebral hemorrhage. After thrombolytic therapy, the patient should still be transferred to a hospital with PCI conditions for further treatment.

Patients with non-ST-segment elevation myocardial infarction should not receive thrombolytic therapy.

5. Medication

Patients with persistent chest pain who are not hypotensive may receive intravenous nitroglycerin. All patients without contraindications should take oral aspirin. Patients with drug-eluting stents should take clopidogrel for one year, while patients without stents can take it for one month. Patients who receive rt-PA thrombolysis or who do not receive thrombolytic therapy can receive subcutaneous injection of low molecular weight heparin or intravenous heparin for 3 to 5 days. Patients without contraindications should be given β-blockers. Patients without hypotension should be given renin-angiotensin transaminase inhibitors (ACEI), and those who cannot tolerate ACEI can use angiotensin receptor blockers (ARB). Verapamil or diltiazem may be given to patients with contraindications to beta-blockers (such as bronchospasm) who have persistent ischemia or atrial fibrillation or atrial flutter with rapid ventricular rate but without heart failure, left ventricular dysfunction, or atrioventricular block. All patients should be given statins.

Many people across our country are suffering from or have suffered from myocardial infarction. The harm caused by myocardial infarction is generally very serious, and it is also something that many people fear. In addition, there are many treatments for myocardial infarction, as can be seen in the article above. With the treatment of myocardial infarction, it will be beneficial for the patient's future disease treatment.