What is the plan of care for a 61-year-old male with an Electrocardiogram (EKG) showing possible anteroseptal myocardial infarction (MI) with involvement of leads V1, V2, V3, and V4, and right axis deviation without ST elevation?

From the Guidelines

The plan of care for a 61-year-old male with an EKG showing possible anteroseptal myocardial infarction in leads V1-V4 and right axis deviation without ST elevation requires immediate cardiac evaluation and initiation of evidence-based medical therapy, including aspirin, clopidogrel, and beta-blockers, as recommended by the 2020 ESC guidelines for the management of acute coronary syndromes 1.

Initial Assessment and Management

The patient should be transferred to the emergency department for cardiac biomarker testing (troponin levels), continuous cardiac monitoring, and supplemental oxygen if saturation is below 94%.

• Initial medication regimen should include aspirin (325 mg chewed immediately), followed by daily 81 mg aspirin
• Consideration of dual antiplatelet therapy with clopidogrel 75 mg daily after a loading dose of 300-600 mg
• Pain management with nitroglycerin (0.4 mg sublingual every 5 minutes for up to 3 doses) is appropriate if systolic blood pressure remains above 90 mmHg
• Beta-blockers such as metoprolol (25-50 mg orally twice daily) should be initiated if there are no contraindications like bradycardia or hypotension

Additional Testing and Risk Stratification

Additional testing should include serial EKGs, complete blood count, comprehensive metabolic panel, lipid profile, and cardiac imaging (echocardiogram) to assess wall motion abnormalities and ejection fraction.

• The absence of ST elevation with anteroseptal changes suggests possible non-ST elevation myocardial infarction (NSTEMI) or unstable angina, which still requires urgent intervention as these conditions carry significant mortality risk
• Cardiology consultation for possible cardiac catheterization should be obtained within 24-48 hours depending on risk stratification and biomarker results, as outlined in the 2020 ESC guidelines 1.
• A stress test is recommended to confirm or establish a diagnosis of coronary artery disease and to assess the risk for future events in patients with coronary artery disease, as suggested by the European Heart Journal study 1.

Ongoing Care and Monitoring

The patient's condition should be closely monitored, and adjustments to the treatment plan should be made as needed based on the results of ongoing testing and evaluation.

• The patient's cardiac biomarker levels, including troponin, should be closely monitored to assess for any changes that may indicate a worsening of the patient's condition
• The patient's EKG should be continuously monitored to assess for any changes that may indicate a worsening of the patient's condition
• The patient's vital signs, including blood pressure, heart rate, and oxygen saturation, should be closely monitored to assess for any changes that may indicate a worsening of the patient's condition.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Plan of Care for a 61-year-old Male with Possible Anteroseptal Myocardial Infarction

The plan of care for a 61-year-old male with an Electrocardiogram (EKG) showing possible anteroseptal myocardial infarction (MI) with involvement of leads V1, V2, V3, and V4, and right axis deviation without ST elevation may involve the following:

• Antiplatelet therapy: Aspirin, clopidogrel, and a glycoprotein IIb-IIIa inhibitor may be used to reduce the risk of further ischemic events 2
• Anticoagulant therapy: Enoxaparin or unfractionated heparin may be used to reduce the risk of thrombosis 3
• Percutaneous coronary intervention (PCI): PCI may be performed to restore blood flow to the affected area of the heart 4, 2
• Monitoring: Continuous ECG monitoring and serial troponin levels may be used to monitor for ischemia and myonecrosis 3, 5

Medications

The following medications may be used in the treatment of this patient:

• Aspirin: to reduce the risk of further ischemic events 2, 6, 3
• Clopidogrel: to reduce the risk of further ischemic events 2, 6, 3, 5
• Glycoprotein IIb-IIIa inhibitor: to reduce the risk of further ischemic events 2, 6, 3
• Enoxaparin or unfractionated heparin: to reduce the risk of thrombosis 3
• Eptifibatide: to reduce the risk of further ischemic events 4, 3

Procedures

The following procedures may be performed in the treatment of this patient:

• PCI: to restore blood flow to the affected area of the heart 4, 2
• Coronary angiography: to visualize the coronary arteries and identify any blockages 5
• ECG monitoring: to monitor for ischemia and arrhythmias 3, 5