Treatment of acute myocardial infarction

The article is professionally consulted by the Doctor of Cardiology Interventional Unit, Vinmec Times City International General Hospital.

Acute myocardial infarction is necrosis of any amount of myocardium due to ischemic causes. The treatment of acute myocardial infarction should be done urgently and properly in order to minimize the mortality rate and complications caused by this pathology.

Patients can recognize acute myocardial infarction through typical signs such as:
Typical angina: pain like squeezing pain in the back of the breastbone or in front of the heart, pain spreading to the left shoulder and the inside of the left hand as far as the ring and little fingers;

The pain usually comes on suddenly, usually lasts more than 20 minutes and does not subside even with nitroglycerin; Pain may radiate to the neck, shoulder, chin, back, right hand or epigastrium; There are cases of patients with myocardial infarction without or with little pain (common in postoperative patients, the elderly, people with diabetes or hypertension); Other symptoms: sweating, shortness of breath, palpitations, vomiting or nausea, confusion, pale skin, cold extremities... These symptoms reflect hypotension or cardiovascular collapse;

Acute myocardial infarction is a super emergency, the patient should be taken immediately to a medical facility as soon as possible for proper and fast management; With the initial treatment, the patient is immobilized in bed, breathing oxygen, taking necessary drugs such as: analgesics, antiplatelet drugs, nitroglycerin, anticoagulants; In addition, the patients were also given measures such as: thrombolysis, percutaneous coronary intervention, emergency coronary artery bypass surgery for myocardial reperfusion; After a successful emergency treatment, the patient continues to be monitored, taking medication along with an appropriate diet and exercise. 2.1 Initial treatment Immediate assessment of the patient's condition and immediate referral to facilities where reperfusion can be performed. The general, initial measures for all patients are:
Patient should be immobilized in bed; Oxygen: at a dose of 2-4 liters/minute through the nose because acute myocardial infarction is often accompanied by hypoxia. Some cases of severe respiratory failure require intubation and appropriate mechanical ventilation; Analgesic: Morphine sulphate is the drug of first choice, the dose is from 2 to 4 mg intravenously, repeated after 5-10 minutes if the patient is still in pain. Pay attention to the patient's breathing rate and heart rate; Nitroglycerin (0.4 mg) sublingually, may be repeated every 5 minutes. Attention should be paid to blood pressure: if the systolic blood pressure is > 90 mmHg, it is good. Next, immediately establish an intravenous line and administer Nitroglycerin at a rate of 10 mcg/min, the dose can be adjusted according to the patient's blood pressure; If blood pressure drops, do not use nitroglycerin, it is necessary to apply vasopressor measures immediately. Note that Nitroglycerin can cause bradycardia and should not be used in the presence of right ventricular myocardial infarction; Antiplatelet drugs: Give aspirin immediately by mouth uncoated, with a loading dose of 160 - 325 mg or can be given intravenously 500mg, can be as an Aspegic powder sachet. If the patient has a history of active peptic ulcer, it can be replaced with Ticlopidine (Ticlid) 250 mg x 2 tablets/day or Clopidogrel (Plavix) for 300 mg immediately, then 75 mg/day; Anticoagulant: Heparin intravenous dose 65 - 70 units/kg then maintain dose 15-18 units/kg/hour; Beta-blockers: The commonly used drug is Metoprolol intravenously 5mg, repeated every 5 minutes until the total dose is 15mg, continue to give 25-50mg orally. Other drugs that can be used are: Atenolol, Esmolol. Do not use these drugs in patients with signs of: severe heart failure, bradycardia <60 beats/min, systolic blood pressure <90 mmHg, high-grade atrioventricular block, obstructive pulmonary disease, severe peripheral vascular disease. 2.2 Reperfusion treatment Coronary intervention in the emergency period (dilation, stenting):

Indications in case:
Acute coronary intervention should be indicated in patients with contraindications to thrombolytics or with unstable hemodynamic status (cardiogenic shock) or arrhythmias; Intervention when using thrombolytic drugs fails: ie, after taking thrombolytic drugs, if the patient still has chest pain, is clinically unstable, and the ST segment is still elevated on the electrocardiogram, there is an indication for arterial intervention. rim. When performing acute coronary intervention, it should be used in combination with drugs:
Aspirin dose of 325mg/day: prolonged use, in combination with Ticlopidine (Ticlid) 250mg x 2 times/day for half a month or Clopidogrel (Plavix) 75 mg/day; GP IIb/IIIa receptor blockers (ReoPro, Aggrastat...) are radical antiplatelet agents. When used together with intervention Acute coronary artery significantly reduces the rate of complications due to intervention and the rate of embolism after intervention; Heparin is required during intervention. If the intervention is successful, it is possible to consider stopping Heparin after the intervention. Emergency coronary-aortic bypass surgery:
Indicated in case:
When the patient has recurrent chest pain after thrombolysis or coronary artery disease is not suitable for intervention (multiple trunk injury, common trunk injury). , complex lesions...), or the intervention fails, the patient has mechanical complications...

In order to prevent recurrence of acute myocardial infarction, patients after discharge from the hospital need to take some preventive measures:
3.1 About nutrition It is necessary to add to the diet seafood: fish, shrimp, shellfish...; Increase the use of green vegetables, fiber, fresh fruits; It is recommended to eat thin porridge, stewed porridge; snacks such as: yogurt products, easy-to-eat soups, vegetable juices that are mashed, boiled, or steamed; abstain from fried, fried and fatty foods...; 3.2 Increase moderate physical activity Based on the physician's instructions when doing stress electrocardiogram and the patient should also listen to his or her own body, do light exercise to the extent that the body sees Comfortable, do not abuse because the more you practice, the faster you will recover from the disease.

3.3 Change your lifestyle Monitor your weight regularly, prevent overweight and obesity, quit smoking, control your blood pressure well, and form a brave mentality to face when living with a heart attack by peace of mind, serenity; Build a moderate lifestyle in terms of time (eating, sleeping, working, resting...). If the patient with a heart attack is not treated, the mortality rate in the first 4 weeks is about 30-40% depending on the country, of these deaths, about half of the cases die within the hour. The first, often unhospitalised, is mainly due to ventricular fibrillation and arrhythmias. Therefore, it is important to seek medical attention and treatment as soon as possible.
To protect your heart health in general and detect early signs of a heart attack in particular, you can sign up for the Cardiovascular Screening Package - Basic Cardiovascular Examination of Vinmec International General Hospital. The examination package helps to detect cardiovascular problems at the earliest through tests and modern imaging methods. The package is for all ages, genders and is especially essential for people with risk factors for cardiovascular disease.
In addition, Vinmec's Cardiology Department always receives a lot of praise and satisfaction from domestic and international customers, being the pioneers in successfully applying the world's most advanced techniques in the treatment of diseases. cardiovascular theory.
A team of highly qualified and experienced specialists: qualified doctors from Master's to Professor's and Doctor's degrees, reputable in medical treatment, surgery, interventional cardiac catheterization. Intensive training at home & abroad. In particular, Prof. TS.BS Vo Thanh Nhan - Cardiology Director of Vinmec Central Park was recognized as the first and only expert in Vietnam to be awarded the "Proctor" certificate on TAVI. State-of-the-art equipment, comparable to major hospitals in the world: The most modern operating room in the world; The most modern silent magnetic resonance imaging machine in Southeast Asia; The CT machine has a super-fast scanning speed of only 0.275s/round without the use of drugs to lower the heart rate; The 16-sequence PET/CT and SPECT/CT systems help detect damage to the cardiovascular organs early even when there are no symptoms of the disease. Applying the most advanced advanced cardiovascular techniques in the world in treatment: Painless open heart surgery; Percutaneous aortic intervention without general anesthesia; Treatment of mitral regurgitation through the catheter has a success rate of 95%; Ventricular-assisted artificial heart transplantation for patients with end-stage heart failure prolongs quality of life beyond 7 years. Cooperating with leading cardiovascular centers in Vietnam and the world such as: National Heart Institute, Cardiology Department of Hanoi Medical University, University of Paris Descartes - Georges Pompidou Hospital (France), University of Pennsylvania (France), University of Pennsylvania (France), University of Pennsylvania (France). United States)... with the aim of updating the most modern cardiovascular treatments in the world. To be examined and treated with leading Vinmec cardiologists, please book an appointment online at the website or contact Vinmec Health System nationwide for service.