CAD

Myocardial Infarction Stabilization

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Myocardial Infarction Stabilization

  • See Also
  1. Chest Pain
  2. Cardiac Risk Factors
  3. Angina
  4. Angina Diagnosis
  5. Unstable Angina
  6. TIMI Risk Score
  7. Bosner Chest Pain Decision Rule
  8. Acute Coronary Syndrome
  9. Acute Coronary Syndrome Immediate Management
  10. Acute Coronary Syndrome Adjunctive Therapy
  11. High Risk Acute Coronary Syndrome Management
  12. Moderate Risk Acute Coronary Syndrome Management
  13. Low Risk Acute Coronary Syndrome Management
  14. Serum Cardiac Markers
  15. Electrocardiogram in Myocardial Infarction
  16. Echocardiogram in Myocardial Infarction
  17. Goldman Criteria for ICU Chest Pain Admission
  • Course
  • Hospital
  1. See Goldman Criteria for ICU Chest Pain Admission
  2. Angiography, Angioplasty and stenting has modified the inpatient ACS protocol dramatically
  3. Prior protocols with prolonged hospital stays, ICU admits and prolonged Heparin have been replaced
  4. Evaluation prior to discharge
    1. Echocardiogram prior to discharge
    2. Consider sub-maximal stress test prior to discharge
    3. See Post Myocardial Infarction Evaluation
  • Disposition
  • Discharge Planning
  1. See Activity after Myocardial Infarction
  2. See Post Myocardial Infarction Evaluation
  3. See Post Myocardial Infarction Medications
  • Complications
  1. Post-MI Pericarditis (common)
  • Prognosis
  • Serum markers for worse prognosis
  1. C-Reactive Protein (CRP) increased
  2. White Blood Cell Count increased (Leukocytosis)
    1. Sabatine (2002) J Am Coll Cardiol 40:1761-8 [PubMed]
  • Prognosis
  • Risk of subsequent infarction or death
  1. Age over 70 years
  2. Left Ventricular Ejection Fraction under 40%
  3. Congestive Heart Failure
  4. Residual ischemia
    1. Post-infarct Angina
    2. Exercise-induced ischemia by EKG or Imaging
  5. Ventricular ectopy (>10 PVCs per minute)
  6. Non Q-Wave infarction
  7. Diabetes Mellitus
  8. Anterior Myocardial Infarction
  9. Hypertension
  10. Major Depression increases mortality within 4 months
    1. Beck Depression Inventory Score <4: 2.6% mortality
    2. Beck Depression Inventory Score 4-9: 17.1% mortality
    3. Beck Depression Inventory Score >10: 23.3% mortality
    4. Bush (2001) Am J Cardiol 88:337-41 [PubMed]