Treatment Guideline Chart
Myocardial infarction is death of cardiac myocytes (necrosis) caused by prolonged ischemia. The term acute "usually" refers to the time 6 hours to 7 days following pathologic appearance of the infarct.
The patient may experience ischemic-type chest discomfort with accompanying symptoms of nausea, vomiting, dyspnea, diaphoresis, lightheadedness, dizziness, syncope, fatigue and weakness.
Rapid diagnosis and risk stratification of chest pain in patients are important to identify acute myocardial infarction patients who will benefit from reperfusion therapy.

Myocardial%20infarction%20w_%20st-segment%20elevation Patient Education

Patient Education

  • Patient and family should be educated about cerebrovascular disease (CVD)
  • Early warning signs of AMI and appropriate advice on seeking medical attention should be reviewed with the patient and their family
  • Encourage patients to adopt healthy lifestyle modifications and medication compliance prior to discharge and review on each follow-up visit
  • Family members are encouraged to undergo cardiopulmonary resuscitation (CPR) training

Lifestyle Modification

Cardiac Rehabilitation

Secondary prevention program includes:

  • Baseline assessment of patient’s condition
    • Patients with ischemia or arrhythmia are at high risk during cardiac rehabilitation
  • Education and counseling on nutrition and management of lifestyle and medical risk factors
  • Psychosocial health
  • Physical activity
    • Intensity of aerobic and/or resistance exercises should be identified based on patient’s risk stratification
  • Drugs for secondary prevention

Risk Factor Management

Diet Modification

  • Dietary interventions have been shown to be highly effective in preventing recurrent CV events in patients with established CHD
    • Compared to other interventions, dietary changes are very cost effective
  • Primary goal: Overall healthy eating pattern
  • All patients with increased risk of CHD should be given advice and specific recommendations on a healthy diet
    • Family involvement especially the person buying and/or preparing the food is helpful
  • Counsel the patient on the proper diet containing variety of fruits, vegetables, wholegrain cereals, bread, low-fat or nonfat dairy products, legumes, fish, poultry and lean meats
    • Reduce saturated fats <7% of total daily intake
    • Reduce cholesterol intake to <200 mg/day
    • Replace saturated fat partly by complex carbohydrates (grains), partly by monounsaturated and polyunsaturated fats (vegetables and marine animals)
    • Add plant stanol/sterols (2 g/day) and/or viscous fiber (>10 g/day) to diet which may help lower LDL-C
    • Sodium intake should be <2.3 g/day
  • Energy intake should be matched with energy needs

Increase Physical Activity

  • Physical fitness has a direct protective effect on the development of vascular lesions
    • Other risk factors are indirectly and positively influenced by physical fitness (eg lowering LDL-C, TG and raising HDL-C along with reducing weight and BP)
  • Minimum goal: 30-60 minutes of moderate intensity aerobic exercise at least 5x/week
  • All patients should consult their physician prior to initiating vigorous exercise programs
    • Patients with CVD will need to be assessed for risk, preferably with stress test prior to prescription of any exercise program
    • For high-risk patients, medically supervised rehabilitation programs may be considered

Weight Management

  • Risk of coronary disease and mortality is increased in obese patients
    • Obesity also contributes to other CHD risk factors (eg hypertension, low HDL-C, glucose intolerance, etc)
    • The presence of abdominal obesity particularly raises CV risk and waist circumference along with waist:hip ratio should be evaluated
    • Target waist circumference: <102 cm in men, <88 cm in women
  • Weight management and exercise should be prescribed as appropriate in all overweight patients
  • Goal BMI for Asian adults: 18.5-22.9 kg/m2, BMI for American/European adults: 18.5-24.9 kg/m2
  • Initial goal is to reduce body weight by 10% from baseline

Smoking Cessation

  • Cigarette smoking increases the risk for CV disease events
    • Dose-dependent relationship exists between cigarettes smoked and CV risks
    • Studies show that through smoking cessation, patients can reduce mortality in the succeeding years by at least one-third compared to those who continue to smoke
  • Primary goal: Complete smoking cessation
  • Assess patient’s tobacco use and strongly urge patient and family to stop smoking
  • Determine the patient’s degree of addiction and his/her readiness to quit smoking
    • Identify which patients are willing to quit
    • Quit plan should be developed and pharmacological therapy (eg nicotine replacement, Bupropion, Varenicline), counseling and formal cessation programs should be provided, if needed

Moderation of Alcohol Consumption

  • Alcohol has an acute effect in elevating BP
    • High levels of alcohol consumption are associated with a high risk of stroke
  • Primary goal: Patients who drink should limit alcohol intake to ≤20-30 g of ethanol/day for men and ≤10-20 g of ethanol/day for women
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