Complications of treatment of myocardial infarction

Etiology: myocardial infarction due to coronary blood supply is drastically reduced or discontinued, and the corresponding blood supply to the myocardium serious and lasting occurrence of myocardial ischemia and ischemic bad. The most commonly occurred in coronary atherosclerosis on the basis of sustained coronary artery spasm can cause myocardial necrosis. Clinical manifestations: squeezing of the chest pain lasting more intense, rest or nitroglycerin served not eased with sweat, dying flu. A small number of patients without chest pain can be, often sudden heart failure, shock and was found, in particular was particularly prevalent in the elderly. Heart rate can be a fast, low heart sounds, blood pressure and other signs of decline. How to treat: (A) general treatment 1, the rest: the first few days absolute bed, the first two weeks in bed or bedside activities. Oxygen, keep silent. 2, monitoring: continuous monitoring of ECG, blood pressure, respiration 5-7, to serious illness hemodynamic monitoring. 3, analgesics: ① chest pain to nitroglycerin 0.6 mg, or isosorbide dinitrate 10 g sublingual, repeatable delivery. ② papaverine 30 ~ 60 mg intramuscular injection. ③ pethidine 50 ~ 100 mg intramuscular injection, bradycardia more applicable. ④ morphine 5 ~ 10 mg subcutaneous injection, respiratory dysfunction, especially with inferior wall myocardial infarction were cautiously uses AVB. ⑤ pain is not relieved by nitroglycerin 1 mg 5% glucose 100 ml intravenous injection. ⑥ treatment does not alleviate the above may be artificial hibernation therapy, pethidine, 50 ~ 100 ml, promethazine 25 ~ 50 mg, hydrogen lysergic alkali 0.6 ~ 0.9 mg in 5% glucose 500 ml intravenous drip, pay attention to blood pressure. (2) the treatment of complications 1, arrhythmia treatment (see section arrhythmia) 2, the treatment of heart failure: more acute left ventricular failure. To oxygen, morphine, pethidine, mainly diuresis. If the severe acute left ventricular failure, brown edema, the current first choice Sodium Nitroprusside, will be 25 to 50 dissolved in 250 ~ 500 ml of liquid, from 8 to 10 μ g / per minute intravenous drip started, and maintain blood pressure 13.3 ~ 14.6 Kpa can join dopamine 20 ~ 60 mg. It is not appropriate at the same time or prior use of diuretics. Other expansion of the industry can be used as medicine nitroglycerin infusion; captopril oral 25 mg three times daily; Chat of Doxazosin 2.5 to 5 mg every 6 to 8 hours 1st. Acute myocardial infarction within 24 hours should avoid the use of digitalis drugs, such as expansion of the drug ineffective and have heart failure, heart expand, can be used with care, suitably rapid excretion of the West to Portland 0.2 ~ 0.4 mg, diluted slow intravenous injection. The view was expressed that the use of myocardial infarction heart failure drug Mao Xuan Makino glycosides K West is superior to Portland, intravenous dosage 0.125 mg per day 1-2 times. 3, Shock treatment (1) Removal of etiology: analgesics, rehydration, correct serious arrhythmias. And oxygen, correct pH, water electrolyte imbalance. (2) Expansion: central venous pressure, pulmonary wedge pressure may try to lower intravenous rehydration, as no significant renal dysfunction, generally 24 hours of domestic demand added from 2000 to 3000 ml of liquid can be used saline, low molecular weight dextran, transfusion patients should pay attention to when breathing, heart rate, lung the Romanian Ministry of the sound changes. However, central venous pressure> 18 cm H2O, pulmonary wedge pressure> 2.4 Kpa infusion should be stopped. (3) Boost Medicine: After inhaling oxygen, expansion, correct acid treatment, shock no better, no obvious signs of heart failure, pulmonary wedge pressure were normal, can be dopamine 20 ~ 40 mg,阿拉明10 ~ 20 mg 100 ml fluid infusion; poor, dobutamine 20 ~ 40 mg or norepinephrine 0.5 to 1 mg 100 ml fluid infusion, systolic blood pressure remained at 13.3 ~ 16 KPa (10 to 120mmHg) (4) vasodilative Medicine: blood pressure does not rebound, pulmonary wedge pressure higher than normal, low cardiac output, peripheral circulation bad, or with significant left heart failure, pulmonary edema can be combined with expansion of the drug. Sodium Nitroprusside 25 mg to join the 250 ml liquid infusion, or nitroglycerin 1 mg, phentolamine 10 ~ 20 mg 100 ml liquid in the intravenous drip.