Acute myocardial infarction new concept of governance

The treatment of acute myocardial infarction, in addition to regular oxygen, transfusion, pain and electrocardiogram, blood pressure monitor, in recent years with the pathophysiology of acute myocardial infarction have deepened understanding of their treatment there has been new concept. That is, but not how to protect ischemic myocardial necrosis, to the extent possible, more than survive, the infarct area narrowed to a minimum. Its central idea is that an early resumption of cardiac blood supply. Through the 1980s, acute myocardial infarction for coronary angiography confirmed that the infarction within one hour after the contrast, 90 percent of occlusion of vascular thrombosis, acute myocardial infarction confirmed the formation of coronary thrombosis is the result. Therefore the coronary or intravenous thrombolytic therapy to restore myocardial revascularization, myocardial save the dying reasonable treatment. At present substantial clinical data show that the effect of certain treatments. If unsuccessful thrombolysis can be PTCA, particularly high-risk patients (anterior infarction, and infarction, left ventricular dysfunction), as soon as possible reconstruction of blood supply. However, surgery must be early, in case of myocardial necrosis, PTCA no significant effect. Myocardial infarction is due to continuing severe myocardial ischemia, resulting in myocardial necrosis, which is a process of development, often is the center of necrosis, ischemia is a serious field, and then gradually reduce the external ischemia. Serious areas of myocardial ischemia or continue to ischemia and necrosis, or for the improvement of local blood supply to reduce ischemia. Therefore, do everything possible to improve cardiac blood supply, oxygen supply, energy supply, so that serious ischemic myocardial ischemia reduce regard to the transformation of the narrow area of infarction. Specific methods are: (1) an increase in myocardial oxygen supply: ① continuous oxygen; ② expansion of coronary artery, improving coronary circulation; ③ assisted circulation, such as external counterpulsation, aortic balloon pump. (2) reduce the myocardial oxygen consumption: ① reduce the heart before and after the load; ② slow down heart rate; ③ rest, sedation, pain, and maintain smooth stool. (3) increased myocardial energy supply: polarization of myocardial provide for the application of anaerobic metabolism of matrix. (4) thrombolytic therapy: intravenous infusion of urokinase or coronary or thrombolytic agents such as streptokinase.