From the Guidelines
The treatment of myocardial infarction (MI) should prioritize immediate medical attention, with a comprehensive approach including aspirin, nitroglycerin, and reperfusion therapy, as well as long-term management with dual antiplatelet therapy, beta-blockers, ACE inhibitors/ARBs, and high-intensity statins, as supported by the most recent guidelines 1.
Initial Management
Initial management of MI includes administering aspirin (325mg chewed) and nitroglycerin for chest pain relief, along with oxygen if saturation is low.
- Aspirin should be given indefinitely at a dose of 81mg daily 1.
- Nitroglycerin should be used for 24 to 48 hours after hospitalization, with careful titration to effect 1.
Reperfusion Therapy
In the hospital, reperfusion therapy is crucial, with primary percutaneous coronary intervention (PCI) being preferred if available within 90 minutes of first medical contact 1.
- If PCI is unavailable, fibrinolytic therapy (such as alteplase, reteplase, or tenecteplase) should be given within 30 minutes of hospital arrival for STEMI patients.
Long-term Management
Standard medication regimens include:
- Dual antiplatelet therapy with aspirin (81mg daily indefinitely) plus a P2Y12 inhibitor like clopidogrel (75mg daily), ticagrelor (90mg twice daily), or prasugrel (10mg daily) for at least 12 months 1.
- Beta-blockers (such as metoprolol 25-100mg twice daily) should be administered to all patients with MI without contraindications for their use, with a treatment course of at least 3 years 1.
- ACE inhibitors/ARBs (like lisinopril 5-40mg daily) and high-intensity statins (atorvastatin 40-80mg or rosuvastatin 20-40mg daily) are also essential.
Lifestyle Modifications
Cardiac rehabilitation and lifestyle modifications including smoking cessation, diet changes, and regular exercise are vital components of long-term management.
- These modifications can help reduce mortality by preventing recurrent events, reducing cardiac workload, promoting favorable remodeling, and stabilizing atherosclerotic plaques.
From the FDA Drug Label
Myocardial Infarction Early Treatment During the early phase of definite or suspected acute myocardial infarction, initiate treatment with metoprolol tartrate as soon as possible after the patient’s arrival in the hospital.
Metoprolol tartrate injection is indicated in the treatment of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality.
The treatment for Myocardial Infarction (MI) includes:
- Metoprolol tartrate injection, which can be initiated as soon as the patient's clinical condition allows, to reduce cardiovascular mortality 2, 2.
- Clopidogrel tablets have been shown to reduce the rate of myocardial infarction (MI) and stroke in patients with acute coronary syndrome, including those with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) 3. Key points to consider:
- Initiation of treatment: Metoprolol tartrate can be initiated as soon as possible after the patient's arrival in the hospital, while clopidogrel tablets can be initiated with a single 300 mg oral loading dose and then continued at 75 mg once daily.
- Dosage and administration: The dosage and administration of metoprolol tartrate and clopidogrel tablets vary, and should be followed according to the drug label instructions.
From the Research
Treatment for Myocardial Infarction (MI)
The treatment for Myocardial Infarction (MI) includes:
- Aspirin to prevent blood clotting 4, 5, 6, 7
- Nitroglycerin to treat chest pain and improve oxygen supply to the heart 4, 5, 8
- Thrombolytic or clot dissolving drugs such as tissue plasminogen activator, streptokinase or urokinase to dissolve arterial blockage 4, 5, 7
- Painkillers such as morphine or meperidine to relieve pain 4, 8
- Antihypertensive drugs such as beta-blockers, ACE inhibitors or calcium channel blockers to lower blood pressure and improve oxygen demand of the heart 4, 5, 7, 8
- ECG, coronary angiography and X-ray of heart and blood vessels to observe the narrowing of coronary arteries 4
Medications
Medications used to treat MI include:
- Aspirin: should be administered on day 1 of an acute MI and continued indefinitely 5
- Beta-blockers: should be used early intravenously and continued orally for 2 to 3 years 7
- ACE inhibitors: should be used in patients with acute MI with ST-segment elevation in two or more anterior precordial leads 5
- Thrombolytic agents: should be used within 6 hours of onset of symptoms 7
- Nitroglycerin: should be used intravenously for the first 24 to 48 hours in patients with acute MI and CHF, large anterior MI, persistent ischemia or hypertension 5
Timing of Treatment
The timing of treatment is crucial in MI, with early administration of aspirin and thrombolytic agents associated with improved survival 6, 7