Author/Editor     Sinkovič, Andreja
Title     Bolnik z akutnim miokardnim infarktom - ukrepi ob akutnem dogodku in ukrepanje v bolnišnici
Type     članek
Source     Med Razgl
Vol. and No.     Letnik 49, št. Suppl 1
Publication year     2010
Volume     str. 49-52
Language     slo
Abstract     Indirect clinical evidence of acute myocardial infarction (AMI) includcs the detection of increased levels of cardiac biomarkers such as troponin I or T, together with a history of chest pain or ECG-changcs, or imaging evidence of new regional wall motion abnormality or new loss of viable myocardium. AMI leads to the loss of functional myocardium, the consequenccs of AMI - in particular with ST-elevation - are heart failure, arrhythmias, sudden death and increased mortality. Therefore, in AMI with ST-elevation, early diagnosis and treatment are mandatory. Treatment in the field includes MONA, heparin, clopidogrel and safe transport of patients to an interventional centre in order to start early reperfusion therapy. In-hospital treatment in an interventional centre encompasses primary percutaneous coronary intervention (PCI) combined with antiaggregation and anticoagulant therapy. In the first 2-3 hours, iv. fibrinolysis is an acceptable alternative if primary PCI is not available. In-hospital treatment is prolonged in case of complications. Secondary prevention of atherosclerosis with statins is initiated early during in-hospital stay, as well as treatment with ACE-inhibitors, which prevent remodelling and thus improve survival after AMI. Morbidity and mortality after AMI, in particular with ST-elevation, can be reduced by early reperfusion therapy and early start of ACE-inhibitors and statins.
Summary     Akutni miokardni infarkt (AMI) dokažemo klinično s povišanimi vrednostmi označevalca ishemične nekroze troponina I ali T skupaj s prsno bolečino ali spremembami v EKG ali dokazi za novo lokalizirano motnjo krčljivosti ali viabilnosti miokarda s slikovnimi preiskavnimi metodami. AMI vodi do izgube kontraktilne mase. Zato so po njem, zlasti z dvigom spojnice ST v EKG, pogosti zapleti, in sicer srčno popuščanje, aritmije, nenadna srčna smrt, in povečana umrljivost. Tako je pri AMI z dvigom ST nujno zgodnje prepoznavanje in ukrepanje že na terenu (MONA, heparin, klopidogrel) ter varen transport v interventni center zaradi zgodnjega reperfuzijskega zdravljenja. Bolnišnično zdravljenje obsega primarno perkutano koronarno intervencijo (PKI), kombinirano z antiagregacijskimi in antikoagulantnimi sredstvi. V prvih 2-3 urah je alternativa iv. fibrinoliza, če primarna PKI ni izvedljiva. Bolnišnično zdravljenje podaljšajo morebitni zapleti. Že v bolnišnici se prične sekundarna preventiva ateroskleroze s statini in zdravljenje z zaviralci konvertaze, ki preprečijo remodelacijo in s tem izboljšajo preživetje po AMI. Zbolevnost in umrljivosti po AMI, zlasti z dvigom ST, lahko zmanjšamo z zgodnjim reperfuzijskim zdravljenjem in zgodnjo uvedbo zaviralca konvertaze ter statina.
Descriptors     MYOCARDIAL INFARCTION
REPERFUSION
ANGIOTENSIN-CONVERTING ENZYME INHIBITORS