Acute Myocardial nfarction

The National Heart Lung and Blood Institute has established the principle that routine AMI patients should receive emergency reperfusion therapy, either fibrinolytic therapy initiated within 30 min or angioplasty within 60 min after arrival in the emergency department. There are four general criteria for emergent fibrinolytic therapy in AMI: (1) clinical presentation consistent with AMI within 12 h of symptom onset, (2) an electrocardiogram showing ST-segment elevation in two or more contiguous leads or new-onset left bundle branch block, (3) absence of contraindications ( Tabje...216z3), and (4) absence of cardiogenic shock. Angioplasty, if available within 60 min of presentation, are preferred over peripheral fibrinolytic therapy for AMI with cardiogenic shock. Important additional considerations, however, include patient age, location of the infarct, relative contraindications to fibrinolysis, and duration of symptoms within the 12-hour criterion.

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