Treatment and first aid measures of acute myocardial infarction

Sudden acute myocardial infarction is likely to lead to life-threatening, and more and more people lose their lives because of acute myocardial infarction. How to deal with acute myocardial infarction in emergency? The following is the information I have compiled for you about the treatment and emergency measures of acute myocardial infarction for your reference.

Treatment of acute myocardial infarction 1. Monitoring and general treatment

The patients without complications were absolutely bedridden in acute phase1~ 3 days; Oxygen inhalation; Continuous ECG monitoring, observing the changes of heart rate and rhythm, blood pressure and respiration, and monitoring pulmonary capillary wedge pressure and static pulse pressure in patients with hypotension and shock when necessary. Low salt, low fat, a small amount of meals, keep the stool unobstructed. After 3 days, the patients without complications gradually moved to the chair beside the bed to eat, defecate and do indoor activities. Generally can be discharged within 2 weeks. Patients with heart failure, severe arrhythmia, hypotension, etc. It is necessary to extend their bed rest and discharge time as appropriate.

2. Sedate and relieve pain

A small amount of morphine intravenous injection is the most effective analgesic, and dolantin can also be used. People who are irritable and nervous can take diazepam orally.

3. Adjust blood volume

Establish venous access as soon as possible after admission, and slowly replenish fluid in the first 3 days, paying attention to the balance of inflow and outflow.

4. Reperfusion therapy to reduce infarct size.

Reperfusion therapy is the most important treatment for acute st segment elevation myocardial infarction. Opening the occluded coronary artery and restoring blood flow within 0/2 hours of onset/kloc-can reduce the area of myocardial infarction and reduce death. The sooner the coronary artery is reopened, the greater the benefit to the patient. ? Time is the heart muscle, and time is life? . Therefore, all patients with acute ST-segment elevation myocardial infarction must be diagnosed as soon as possible after seeing a doctor, and the strategy of reperfusion treatment should be formulated as soon as possible.

Direct coronary intervention (PCI)

In a hospital with emergency PCI conditions, all patients with acute ST-segment elevation myocardial infarction within 0/2 hours of onset/kloc-should receive direct PCI if the first balloon dilatation can be completed within 90 minutes after the patient arrives at the hospital and the coronary artery can be recanalized through balloon dilatation, and stents should be placed if necessary. In the acute phase, only infarct-related arteries are treated. Regardless of the onset time, patients with cardiogenic shock should receive direct PCI treatment. Therefore, patients with acute ST-segment elevation myocardial infarction should go to hospitals with PCI conditions as much as possible.

② Thrombolytic therapy

If there is no emergency PCT treatment condition, or if the first balloon dilatation cannot be completed within 90 minutes, and if the patient has no contraindication to thrombolysis, the patient with acute st-segment elevation myocardial infarction should be treated with thrombolysis within 12 hours of onset. 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, and the most serious is cerebral hemorrhage. After thrombolytic therapy, it is still recommended to transfer to a hospital with PCI conditions for further treatment.

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

5. Drug therapy

If there is no hypotension, patients with persistent chest pain can receive intravenous nitroglycerin. All patients without contraindications should take aspirin orally, patients with drug stents should take clopidogrel for one year, and patients without stents can take it for one month. Patients with or without rt-PA thrombolytic therapy can be injected with low molecular weight heparin subcutaneously or intravenous heparin for 3 ~ 5 days. What should patients without contraindications eat? Blocker. Renin-angiotensin transaminase inhibitor (ACEI) should be given to patients without hypotension, and angiotensin receptor blocker (ARB) can be used for patients who cannot tolerate ACEI. Right? Verapamil or diltiazem can be given to patients with contraindications of receptor blockers (such as bronchospasm) and persistent ischemia or atrial fibrillation, atrial flutter with rapid ventricular rate, but no heart failure, left ventricular dysfunction and atrioventricular block. All patients should take statins.

6. Anti-arrhythmia

Occasional ventricular premature beats can be closely observed without drug treatment; When ventricular premature beats or ventricular tachycardia (ventricular tachycardia) occur frequently, lidocaine should be injected intravenously immediately, followed by continuous intravenous drip; When the effect is not good, amiodarone can be injected intravenously. When ventricular tachycardia causes blood pressure reduction or ventricular fibrillation, direct current defibrillation should be used as soon as possible. For bradyarrhythmia, atropine can be injected intramuscularly or intravenously; Temporary pacemaker can be placed during ⅱ ~ ⅲ degree atrioventricular block. Supraventricular arrhythmia: atrial premature beats do not require special treatment. Paroxysmal supraventricular tachycardia and rapid ventricular rate atrial fibrillation can be given intravenous injection of verapamil, diltiazem, metoprolol, digitalis or amiodarone. For scholars with fast ventricular rate and ineffective drug treatment, DC synchronous electrical conversion should be carried out.

7. Treatment of acute myocardial infarction complicated with cardiogenic shock and pump failure

Oxygen should be taken when pulmonary edema occurs, morphine and furosemide should be injected intravenously, and sodium nitroprusside should be dripped intravenously. Cardiogenic shock can be intravenously infused with dopamine, dobutamine or alamin. If blood pressure can be maintained, a small amount of sodium nitroprusside can be added under close observation. When the drug reaction is not good, direct PCI should be carried out with the support of intra-aortic balloon counterpulsation. If coronary angiography is not suitable for PCI, emergency coronary artery bypass surgery should be considered.

8. Pre-discharge evaluation and post-discharge life and work arrangement

Before discharge, 24-hour ambulatory ECG monitoring, echocardiography and radionuclide examination can be performed to find symptomatic or asymptomatic myocardial ischemia and severe arrhythmia, understand cardiac function, estimate prognosis, decide whether revascularization treatment is needed, and guide the activity after discharge.

2 ~ 3 months after discharge, you can resume some work or light physical work as appropriate. After that, some patients can resume full-time work, but they should avoid overwork or stress.

9. Family rehabilitation therapy

Patients with acute myocardial infarction will be allowed to go home for rehabilitation treatment after they spend their acute phase in the hospital.

(1) Take medicine on time and make regular follow-up visits; Keep the stool unobstructed; Adhere to moderate physical exercise.

(2) Don't get emotional and overworked; Quit smoking, limit alcohol and avoid overeating.

Emergency measures for acute myocardial infarction 1, once diagnosed as acute? Myocardial infarction? Immediately let the patient lie on his back nearby to ensure smooth breathing, unbutton his belt and chest buttons, and avoid activities and exertion. When vomiting, you should tilt your head to one side and clean your mouth to prevent vomit from blocking your trachea. Continuous sublingual administration of nitroglycerin, Suxiao Jiuxin Pills or isosorbide dinitrate.

2, weak breathing, unconsciousness, blue face, immediately do chest compressions and mouth-to-mouth artificial respiration.

3. Is it acute at present? Myocardial infarction? The treatment point of view is that patients are advised to go to a conditional hospital for thrombolysis, intervention and surgical treatment as soon as possible, and visit the emergency department within 1 hour after onset, which can save most necrotic myocardium; Within 6 hours, it is possible to save some myocardium; 12 hours later, the effect is obviously not good.

4. In case of acute myocardial infarction, you must seek medical attention immediately. Everyone must know the first aid measures for myocardial infarction and wait for the arrival of the emergency doctor. Because the condition of sudden myocardial infarction is very dangerous, only knowing the relevant first aid methods can save patients from greater danger. Finally, we should advise you to actively prevent myocardial infarction.

Precursor of myocardial infarction 1, pain

This is the first symptom. The location and nature of pain are the same as angina pectoris, but it often occurs in quiet or sleep. The pain is severe and extensive, and can last for hours or days. Rest or nitroglycerin tablets can't relieve it. Patients are often anxious, sweating, afraid and have a sense of dying.

2. Systemic symptoms

Mainly fever, accompanied by tachycardia, leukocytosis and accelerated erythrocyte sedimentation rate, which is caused by the absorption of necrotic substances. It usually appears 24-48 hours after the pain occurs, and its degree is often positively correlated with the infarct area. The body temperature is generally around 38℃, and rarely exceeds 39℃ for a week.

3, gastrointestinal symptoms

About13 of the pain patients are accompanied by nausea, vomiting and epigastric pain in the early stage of the disease, which is related to the insufficient tissue perfusion caused by the stimulation of vagus nerve by necrotic myocardium and the decrease of cardiac output. Flatulence is not uncommon; In severe cases, you will burp.

4. arrhythmia

It occurs in 75%-95% of patients, mostly within 0-2 weeks after onset, especially within 24 hours. Diffuse abnormality may appear in electrocardiogram.

5, hypotension and shock

During the period of pain, it can lead to a drop in blood pressure, which may last for several weeks and then rise again, and often cannot be restored to the previous level. If the pain is relieved and the systolic blood pressure is lower than 80mmHg, the patient's fidgety, pale face, wet and cold skin, thin and fast pulse, sweating, decreased urine output, mental retardation and even fainting are all manifestations of shock.

6. Acute left heart failure