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ST-elevation myocardial infarction: Difference between revisions
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[[Nitroglycerine]], either sublingual tablets or sprays, should only be given if the patient has pain. It may be administered to the patient up to three times but does not improve outcome and is therefore not given routinely to all. Nitroglycerine is contraindicated in right ventricular infarction and should therefore not be administered if right ventricular infarction is suspected. | [[Nitroglycerine]], either sublingual tablets or sprays, should only be given if the patient has pain. It may be administered to the patient up to three times but does not improve outcome and is therefore not given routinely to all. Nitroglycerine is contraindicated in right ventricular infarction and should therefore not be administered if right ventricular infarction is suspected. | ||
[[Aspirin]] (300 mg) should be administered to all patients to be chewed and swallowed in all cases of STEMI. In addition to this, a loading dose of a [[P2Y12 inhibitor]] like | In the ambulance, [[Aspirin]] (300 mg) should be administered to all patients to be chewed and swallowed in all cases of STEMI. In addition to this, a loading dose of a [[P2Y12 inhibitor]] like clopidogrel (Plavix®) or ticagrelor should be administered. [[Unfractionated heparin]] (<abbr>UFH</abbr>) is administered to all patients unless they’re already anticoagulated. | ||
Following entry to the hospital, the following two medications may be considered. They are secondary prophylaxis but can usually be started the same day or the day after: | |||
[[Beta blocker|Beta blocker,]] most often metoprolol, should be administered in all cases where the patient does not have signs of heart failure and is haemodynamically stable. | [[Beta blocker|Beta blocker,]] most often metoprolol, should be administered in all cases where the patient does not have signs of heart failure and is haemodynamically stable. | ||
[[Atorvastatin]] | High intensity statin ([[Atorvastatin]] 40-80 mg or [[rosuvastatin]] 20-40 mg) should be administered to all patients as soon as possible. | ||
If the anatomy is unsuitable for PCI and the infarcted myocardial area is large, or there is cardiogenic shock, emergency [[coronary artery bypass surgery]] (<abbr>CABG</abbr>) should be performed. | If the anatomy is unsuitable for PCI and the infarcted myocardial area is large, or there is cardiogenic shock, emergency [[coronary artery bypass surgery]] (<abbr>CABG</abbr>) should be performed. | ||
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* Aspirin (300 mg loading dose) – in all cases | * Aspirin (300 mg loading dose) – in all cases | ||
* P2Y12 inhibitor loading dose ( | * P2Y12 inhibitor loading dose (clopidogrel or ticagrelor) – in all cases | ||
* Atorvastatin – in all cases | * Atorvastatin – in all cases | ||
* Unfractionated heparin – in all cases except with pre-existing anticoagulation | * Unfractionated heparin – in all cases except with pre-existing anticoagulation | ||