Acute Myocardial Infarction - Essay Example

A key element is the type of chest pain which is to be identified from typical angina, atypical angina or non-anginal chest pain. Recognizing AMI and its severity cannot be done without an electrocardiogram (ECG). This means an ECG needs to be done immediately on a patient presenting with chest pain. In patients with new or typical chest pain ST elevation of more than 1mm in two or more contiguous limb leads, or equal to 2mm or more precordial leads these findings show that they need to be considered as having AMI.

Patients that show new or presumably new left bundle branch block (LBBB); the treatment mode is the same as that which is given to patients with ST-segment elevation. This is despite the fact that some of the patients presenting with LBBB may not prove to have AMI. The reason for this is that thrombolytic therapy of patients with LBBB is found to reduce patient mortality.Treatment Early treatment involves the use of aspirin, heparin, enoxaparin, nitrates, beta-blockers, and clopidogrel. Aspirin reduces the possibility of mortality, reinfarction, and stroke.

Combining heparin/enoxaparin in conjunction with aspirin and reperfusion therapy is not universally accepted, but it appears to enhance patency. All patients with AMI should be given chewable aspirin as soon as it is possible and continued indefinitely. For patients unable to take aspirin, clopidogrel is the alternative. When the probability of urgent coronary artery bypass graft is low early use of clopidogrel should be considered. Evidence supports the use of enoxaparin as an alternative to intravenous heparin.

In high risk patients early use of subcutaneous low-molecular-weight heparin (enoxaparin 1mg/kg subcutaneous every 12 hours) or intravenous unfractionated heparin (70units/kg load then 12 to 15 units/kg/hr to achieve partial thromboplastin time levels 1.5 to 2.5 the control) with aspirin and/or clopidogrel is known to decrease the incidence of AMI and ischemia. Enoxaparin has demonstrated a moderate benefit over intravenous access heparin in reducing the mortality rate, myocardial infarction, and recurrent ischemia.

However, enoxaparin needs to be used with caution in patients with renal insufficiency (Diagnosis and Treatment of Chest Pain and