Management of Acute Myocardial Infarction

Abstract

Acute myocardial infarction (AMI) could be considered as one of the most important illnesses of our century. In the beginning of the twentieth century, acute coronary occlusion was expected to be immediately fatal, but very soon it became clear that some patients might survive the acute event. After 1960 the medical therapy comprised only analgesia, bed rest and sedation. With the advent of electrocardiographic monitoring, defibrillators and potent antiarrhythmic drugs the hospital mortality secondary to electrical instability was markedly reduced from approximately 30% to 15%. Left ventricular pump failure became the major cause of hospital deaths in late 1960s. As the amount of myocardial necrosis obtained the pivotal role, all attempts were focused toward reducing the myocardial injury by improving the balance between oxygen demand and supply in the jeopardised myocardium. One of the major improvements of the infarction treatment was the development of intracoronary and intravenous thrombolysis. Myocardial salvage became reality and was defined as the act of rescuing and recovering of myocardium following the acute occlusion of the coronary artery. It resulted in reduction of the infarct size, preservation of the ejection fraction and reduction of mortality.