Treatment of Acute Myocardial Infarction

1. Basic principles of treatment for acute myocardial infarction

· Rapidly reopen the blocked coronary artery to minimize the area of infarction

· Minimize death due to arrhythmia, since most arrhythmia-related deaths occur within 24 hours and more than half of patients die within the first hour

2. Emergency measures a patient can take when acute myocardial infarction occurs

· Stay still if possible.

· Do not hesitate to call 119 and go to a hospital where primary coronary intervention is available.

· Do not waste time on ineffective herbal medicines, or at a private clinic, pharmacy, or Korean medicine clinic.

· To prevent myocardial necrosis as much as possible, visit a hospital as soon as possible after symptoms begin, ideally within 6 hours or at least within 12 hours.

3. General treatment for patients with acute myocardial infarction

1. Aspirin

The first medication administered to patients with acute myocardial infarction

2. Relief of chest pain

When the patient arrives at the hospital, chest pain is controlled and the myocardium’s oxygen demand is reduced through sublingual nitroglycerine, intravenous morphine, and intravenous beta blockers. However, nitroglycerine is contraindicated in cases of hypotension, right ventricular infarction, or sildenafil (Viagra) use within the past 24 hours.

3. Anticoagulant therapy

Heparin, platelet aggregation inhibitors, etc.

4. Reperfusion treatment for patients with acute myocardial infarction

1. Thrombolytic agents

Acute myocardial infarction occurs because the coronary artery is blocked by a thrombus (blood clot), so treatment that dissolves the clot can be used; this is called a thrombolytic agent.

As a rule, thrombolytic agents are administered intravenously within 30 minutes of the patient’s arrival at the emergency room. The best effect can be achieved when treatment is given within 1–3 hours after symptom onset, so it is important for the patient to come to the hospital as soon as possible after symptoms begin. Thrombolytic treatment is useful for patients who arrive within 3 hours of symptom onset, and its treatment effect is similar to that of primary coronary angioplasty.

The problem with thrombolytic treatment is that the recanalization success rate is low at about 60–70%, the recurrence rate is high (10–15%), and there is a possibility of serious bleeding, so it is not widely used these days.

2. Primary coronary angioplasty

Primary coronary angioplasty refers to promptly performing coronary balloon angioplasty and stent insertion when a patient with acute myocardial infarction arrives at the hospital. It is the best method for reopening an occluded vessel, and because the recanalization success rate is high at 95–99%, it is currently the most commonly used reperfusion treatment.

As a rule, primary coronary angioplasty should be performed within 90 minutes after the patient arrives at the hospital, and the sooner it is done, the better the effect. Primary coronary angioplasty is useful for patients who arrive within 12 hours of chest pain onset, and is performed even after 12 hours if chest pain continues. If primary coronary angioplasty is performed within 2–3 hours of chest pain onset and recanalization is successful, normal cardiac function can be maintained without myocardial necrosis.

The recurrence rate was somewhat high at about 20–30% when regular stents were used, but to reduce recurrence, drug-eluting stents coated with medication that suppresses restenosis have been used, reducing the recurrence rate to 5–10%. A problem with drug-eluting stents is that stent thrombosis can occur in a very small number of patients, which is being prevented with antiplatelet therapy using aspirin and clopidogrel.

3. Reasons for delayed coronary reperfusion treatment and ways to improve it

After chest pain begins, do not waste time waiting with vague hope that it will “get better,” and do not waste time visiting a private clinic, pharmacy, or Korean medicine clinic. If chest pain lasts longer than 10 minutes, call 119 immediately and be transported quickly (step A) to a hospital where primary coronary intervention is available (step B). To ensure that emergency coronary intervention can be performed 24 hours a day at the hospital, an emergency coronary intervention team should always be on standby, and the procedure should be performed promptly when the patient arrives.

So far, I have explained the treatment of acute myocardial infarction.

In the next installment, we will look at growth disorders.

Source: Korea Centers for Disease Control and Prevention, National Health Information Portal