Reconsideration of Acute Myocardial Infarction AMI , December 14, 1998

Reconsideration of Acute Myocardial Infarction (AMI), December 14, 1998

AMI and angina pectoris both belong to coronary heart disease. Angina is a brief, few-second chest pain, while AMI is a prolonged, severe chest pain that can radiate to the left arm and left shoulder. The duration of an MI can last for hours or even days, during which patients may experience low blood pressure, increased white blood cells, elevated neutrophils, accelerated erythrocyte sedimentation rate, and other symptoms. Complications such as heart failure, pulmonary embolism, and cardiac rupture may also occur. Treatment principles: ① Rest and oxygen therapy; pain relief can be achieved with pethidine or strong analgesics, and once the pain subsides, the heart’s oxygen consumption decreases, which is the main issue in treating this condition; ② Antibiotics: their use is essential because the infarcted myocardium is prone to rapid infection; ③ Coronary vasodilation: nitroglycerin 0.2–0.3 mg sublingually, or 1 mg added to 40 mL of 10% glucose for intravenous drip, or 5 mg added to 500 mL of 10% glucose for intravenous drip; Isosorbide dinitrate can be taken sublingually or orally; beta-blockers like propranolol and calcium channel blockers like nifedipine can also be used; ④ For shock, dopamine, metaraminol, and norepinephrine can be administered; for heart failure, digoxin and cedilan can be used; ⑤ Additionally, considering myocardial nutritional deficiency, insulin 8 U and KCl can be added to 500 mL of hypertonic glucose for intravenous drip, known as nutritional drugs or revitalizing solutions; ⑥ Fibrinolytic drugs such as urokinase 50,000–100,000 U can be added to 5% glucose for intravenous drip, and after stabilization, earthworm kinase No. 2 can be taken orally three times daily; ⑦ Rest and low-flow continuous oxygen administration, with electrocardiographic monitoring; ⑧ Large hospitals with appropriate facilities can insert floating catheters to observe changes in intracardiac hemodynamics, but this procedure must be carried out under strict sterile conditions, which most hospitals cannot meet.