Therapy is aimed at reversing ischemia to preserve cardiac muscle function, reduce the infarct size, and prevent death. Innovative modalities provide early restoration of coronary blood flow. The use of pharmacologic agents improves oxygen supply and demand, reduces and prevents dysrhythmias, and inhibits the progression of CAD. Immediate reperfusion is desirable.
Oxygen Therapy
- Usually given by nasal cannula.
- Improves oxygenation to ischemic heart muscle.
Pain Control
Endogenous catecholamine release during pain imposes an increased workload on the heart muscle, thus causing an increase in oxygen demand.
- Morphine is used to relieve pain, to improve cardiac hemodynamics by reducing preload and afterload, and to provide anxiety relief.
- Vasodilator therapy consists of nitroglycerin administered sublingually, via I.V., or transdermally.
- Benzodiazepines are used with analgesics when anxiety complicates chest pain and its relief.
Percutaneous Coronary Interventions
- Mechanical opening of the coronary vessel can be performed during an evolving infarction.
- Percutaneous coronary interventions (PCI), including percutaneous transluminal coronary angioplasty, coronary stenting, and arthrectomy can be used instead of or as an adjunct to thrombolytic therapy
Surgical Revascularization
- Emergency CABG surgery can be performed within 6 hours of evolving infarction.
- Definite treatment of the stenosis and less scar formation on the heart are the benefits of this therapy.
Complications
- Rhythm disturbances
- Sudden cardiac death due to ventricular arrhythmias
- Infarct expansion (thinning and dilation of the necrotic zone)
- Infarct extension (additional heart muscle necrosis occurring after 24 hours of acute infarction)
- Heart failure (with 20% to 35% left ventricle damage)
- Cardiogenic shock
- Reinfarction
- Ischemic cardiomyopathy
- Cardiac rupture
- Papillary muscle rupture
- Ventricular mural thrombus
- Thromboemboli
- Ventricular aneurysm
- Cardiac tamponade
- Pericarditis (2 to 3 days after MI)
- Psychiatric problems, depression, personality changes