ACUTE MI AND OTHER ACUTE CORONARY SYNDROMES:
MANAGEMENT OF COMPLICATIONS


I. Treat brady-/tachycardia, if occurring, with

  1. ATROPINE
  2. Beta-BLOCKERS

II. Treat severe CHF, if occurring, with

  1. Diuretics
  2. Afterload reducers
  3. Inotropes, e.g. Dig, Dobutamine, Dopamine, Amrinone

III. Cardiogenic shock

  1. Intra-aortic baloon counterpulsation
  2. Consider emergency angio then PTCA or CABG
    1. Such an approach was ass'd with sig. lower 6mo mortality compared with "initial medical stabilization" (50% vs. 63%)in a randomized study of 302 pts (NEJM 341:625, 1999--JW)

IV. RV infarction with hypotension

  1. Volume expansion with normal saline
  2. Inotropes if hypotension persists

V. Recurrent ischemia

  1. Usually will require angio
  2. May require revascularization by PTCA or CABG
  1. Us. occurs in 1st 24h after admission
  2. If occurring after thrombolysis, consider repeat thrombolysis

VI. Post-MI pericarditis--tx with ASA 650mg Q4-6h

VII. Ventricular tachycardia

  1. If unstable (chest pain, hypotension, pulmonary congestion), shock
  2. If stable, treat with IV lidocaine, procainamide, or amiodarone.