Avtor/Urednik		Remškar, Mojca; Ploj, Tom; Pohar, Bojan; Noč, Marko; Horvat, Matija
Naslov		Zdravljenje akutnega miokardnega infarkta
Prevedeni naslov		Treatment of acute myocardial infarction
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 36, št. 4
Leto izdaje		1997
Obseg		str. 479-505
Jezik		slo
Abstrakt		The patient with acute myocardial infarction must receive oxygen, Aspirin and analgesia with morphine as soon as possible. In most patients, gliceryl trinitrate is also indicated. The doctor should reassure the patient and give him/her a brief explanation of the illness. Upon arrival to the hospital, only the most important investigation should be done before making the decision about reperfusion therapy. Prompt reperfusion is the most effective treatment in acute myocardial infarction. In Slovenia, thrombolytic drugs, including streptokinase, tissue plasminogen activator and urokinase, are mostly used to achieve reperfusion. In some centers, primary (direct) percutaneous transluminal coronary angioplastly has been introduced. During the acute phase of the disease, even a hemodynamically stable patient must rest in bed for the first 12 hours. After that time light physical activity can be started. During the period of bed rest, the patient should be given heparin. All patients, except those with contraindications,must be treated with a beta blocking drug and an ACE inhibitor. The course of Aspirin and beta blocking drugs should be continued indefinitely, while ACE inhibitors are discontinued after 4 to 6 weeks if there are no additional indications. The authors also discuss unexpected and potentially lethal complications that may arise during the acute phase of myocardial infarction.
Izvleček		Takoj po postavitvi diagnoze akutni miokardni infarkt mora bolnik dobiti kisik, Aspirin in po potrebi analgezijo z morfijem. Pri večini bolnikov je indiciran tudi gliceril trinitrat. Bolniku na kratko pojasnimo stanje in ga pomirimo. Ob prihodu v bolnišnico izvedemo le najnujnejše diagnostične postopke in se čim prej odločimo o možnosti reperfuzijskega zdravljenja. Takojšnja reperfuzija je najučinkovitejša metoda zdravljenja. Večinoma jo pri nas izvajamo s trombolitičnimi zdravili (streptokinaza, tkivni aktivator plazminogena in urokinaza), počasi pa se uveljavlja tudi primarna (takojšnja) perkutana transluminalna koronarna angioplastika. V akutnem obdobju bolezni mora tudi hemodinamsko stabilen bolnik prvih 12 ur ležati. Nato prične z lažjimi aktivnostmi, s posedanjem ob postelji ipd. V času omejene telesne akvitnosti mora dobivti heparin. Vsem bolnikom, kinimajo kontraindikacij, uvedemo zdravljenje z blokatorjem adrenergičnih receptorjev beta in inhibitorjem angiotenzinske konertaze. Zdravljenje z Aspirinom inblokatorjem adrenergičnih receptorjev beta nadaljujemo doživljenjsko, inhibitor angiotenzinske konvertaze ukinemo po 4 do 6 tednih, če zanj ni dodatnih indikacij. Pri zdravljenju bolnika z akutnim miokardnim infarktom moramo biti pripravljeni na nenadne, lahko tudi življenjsko ogrožajoče zaplete.
Deskriptorji		MYOCARDIAL INFARCTION INTENSIVE CARE UNITS ACUTE DISEASE THROMBOLYTIC THERAPY ANGIOPLASTY, TRANSLUMINAL, PERCUTANEOUS CORONARY HEPARIN ANTI-ARRHYTHMIA AGENTS PERICARDITIS ARRHYTHMIA