Recent Trends. in Managing Acute Myocardial Infarction

Abstract

As the clinical research moves on at a ferocious pace it is perhaps wise to detach ourselves for a while and analyse as to what we have learnt so far about mana ging acute myocardial infarction (AMI).It is now widey recommended that. in cases of ref ractory malignant ventricular tachyarrythmias intrav enous adrenaline should be given if electrical cardio version is not successful (Table I). In cases of asystole external percutaneous or transe sophageal pace makers can be lifesaving.The benefit of low dose s/c heparin for prophylaxis of D.V.T in high risk patients and of intravenous infusion in unstable angina is clear. The use of heparin in AMI followed by long term anticoagulation has been the subject of much controversy in recent years. Previous studies have shown conflicting results. GISSI 2 addressed this question by giving heparin subcutaneo usly to all the randomised patients after 12 hours of thrombolysis.As a rule all patients should be discharged on a B- Blocker arid aspirin if not contraindicated. The rOle of long term oral anticoagulants after AMI is not certain. Studies in the 1970s demonstrated a 20% reduction in overall mortality after AMI ^2,3•Large well, designed randomised studies are needed in the futpre to evaluate the benefits of long term anticoagulation after the state of the art management.