CAD

Myocardial Infarction Stabilization

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Myocardial Infarction Stabilization

  • Course
  • Hospital
  1. See Goldman Criteria for ICU Chest Pain Admission
  2. Angiography, Angioplasty and stenting has modified the inpatient ACS protocol dramatically
  3. Prior protocols with prolonged hospital stays, ICU admits and prolonged Heparin have been replaced
  4. Evaluation prior to discharge
    1. Echocardiogram prior to discharge
    2. Consider sub-maximal stress test prior to discharge
    3. See Post Myocardial Infarction Evaluation
  • Complications
  1. Pericarditis (common)
  • Prognosis
  • Serum markers for worse prognosis
  • Prognosis
  • Risk of subsequent infarction or death
  1. Age over 70 years
  2. Left Ventricular Ejection Fraction under 40%
  3. Congestive Heart Failure
  4. Residual ischemia
    1. Post-infarct Angina
    2. Exercise-induced ischemia by EKG or Imaging
  5. Ventricular ectopy (>10 PVCs per minute)
  6. Non Q-Wave infarction
  7. Diabetes Mellitus
  8. Anterior Myocardial Infarction
  9. Hypertension
  10. Major Depression increases mortality within 4 months
    1. Beck Depression Inventory Score <4: 2.6% mortality
    2. Beck Depression Inventory Score 4-9: 17.1% mortality
    3. Beck Depression Inventory Score >10: 23.3% mortality
    4. Bush (2001) Am J Cardiol 88:337-41 [PubMed]