Treatment of acute myocardial infarction
The patient with acute myocardial infarction must receive oxygen, Aspirin® and analgesia with morphine as soon as possible. In most patients, gliceryl trinitrate is also indicated. The doctor should reassure the patient and give him/her a brief explanation of the illness. Upon arrival to the hospital, only the most important investigation should be done before making the decision about reperfusion therapy. Prompt reperfusion is the most effective treatment in acute myocardial infarction. In Slovenia, thrombolytic drugs, including streptokinase, tissue plasminogen activator and urokinase, are mostly used to achieve reperfusion. In some centers, primary (direct) percutaneous transluminal coronary angioplasty has been introduced. During the acute phase of the disease, even a hemodynamically stable patient must rest in bed for the first 12 hours. After that time light physical activity can be started. During the period of bed rest, the patient should be given heparin. All patients, except those with contraindications, must be treated with a beta blocking drug and an ACE inhibitor. The course of Aspirin® and beta blocking drugs should be continued indefinitely, while ACE inhibitors are discontinued after 4 to 6 weeks if there are no additional indications. The authors also discuss unexpected and potentially lethal complications that may arise during the acute phase of myocardial infarction.