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Guidelines for Management of Acute Myocardial Infarction

Every patient with acute myocardial infarction should be administered oxygen by nasal prongs, sublingual nitroglycerin unless systolic arterial pressure is less than 90 mmHg or heart rate is less than 50 or greater than 100 beats per minute (bpm) adequate analgesia with morphine sulphate or meperidine and aspirin, 160 to 325 mg orally. A 12-lead electrocardiogram (ECG) should also be performed. ST-segment elevation (equal to or greater than 1 mV) in contiguous leads provides strong evidence of thrombotic coronary arterial occlusion and makes the patient a candidate for immediate reperfusion therapy, either by fibrinolysis or primary percutaneous transluminal coronary angioplasty (PTCA). Patients without ST-segment elevation should not receive thrombolytic therapy. The greatest benefit occurs when thrombolysis is initiated within 6 hours of the onset of symptoms, although it offers definite benefit when begun within 12 hours. Primary PTCA may be performed as an alternative to thrombolytic therapy, provided that it can be accomplished in a timely fashion by persons skilled in the procedure .

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