http://www.fpnotebook.com/
Myocardial Infarction Stabilization
- Course: Hospital
- Cardiac Intensive Care Unit Admission
- Move from Emergency Department within 1-2 hours
- Observe on Critical Care Unit for 24 hours
- Heparin for 48-72 hours
- Coumadin if indicated
- Telemetry (Step Down Unit)
- Observe rhythm with activity for 2-4 days
- Cardiac Rehabilitation
- Education on day 1
- Ambulatory on day 2
- Evaluation prior to discharge
- Echocardiogram prior to discharge
- Consider sub-maximal stress test prior to discharge
- See Post Myocardial Infarction Evaluation
- Discharge
- Day 4-5 in Uncomplicated Myocardial Infarction
- Discharge Planning
- See Activity after Myocardial Infarction
- See Post Myocardial Infarction Evaluation
- See Post Myocardial Infarction Medications
- Complications
- Pericarditis (common)
- Prognosis: Serum markers for worse prognosis
- C-Reactive Protein (CRP) increased
- White Blood Cell count increased (Leukocytosis)
- Sabatine (2002) J Am Coll Cardiol 40:1761
- Prognosis: Risk of subsequent infarction or death
- Age over 70 years
- Left Ventricular Ejection Fraction under 40%
- Congestive Heart Failure
- Residual ischemia
- Post-infarct Angina
- Exercise-induced ischemia by EKG or Imaging
- Ventricular ectopy (>10 PVCs per minute)
- Non Q-wave infarction
- Diabetes Mellitus
- Anterior Myocardial Infarction
- Hypertension
- Major Depression increases mortality within 4 months
- Beck Depression Inventory Score <4: 2.6% mortality
- Beck Depression Inventory Score 4-9: 17.1% mortality
- Beck Depression Inventory Score >10: 23.3% mortality
- Bush (2001) Am J Cardiol 88:337
Navigation Tree
