Out-of-hospital treatment of acute myocardial infarction

Abstract

Patients who experience an acute ST-elevation myocardial infarction (STEMI) present a common clinical problem. While the treatment for this condition has undergone various changes in recent years, the underlying pathophysiology has remained the same. The patient experiences an acute coronary atheromatous plaque which fissures or ruptures, leading to the development of thrombus associated with the acute plaque causing occlusion of the vessel. This causes the typical symptoms of acute STEMI of chest pain, breathlessness, sweating and nausea/vomiting, as well as the classical changes on the resting electrocardiogram (ECG). Once the coronary artery is blocked, the myocardium supplied by the vessel is at risk of necrosis, unless the vessel can be reopened and the blood supply is restored. Time is of the essence, since the quicker the vessel can be reopened, the less myocardial damage occurs. In this article, the use of thrombolysis to treat patients with STEMI is described. This covers its administration within the hospital setting and its use prehospital. The treatment of patients with STEMI using coronary angioplasty/stenting is addressed, including the assessment of the patient, the procedure itself and also the care of the patient following the procedure.