Acute Transmural Myocardial Infarction

Patients with transmural (with ST segment elevation) myocardial infarction should immediately be considered for reperfusion therapy. Fibrinolytic therapy with streptokinase, alteplase, or reteplase should be started within 30 minutes of presentation for patients without bleeding risk. Alternatively, patients at tertiary care hospitals can undergo emergency coronary angioplasty. Other lifesaving pharmacologic interventions include administering aspirin, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors. Oxygen, morphine sulfate, heparin, and nitroglycerin are also useful. No benefit has been demonstrated for calcium channel blockers, magnesium, or prophylactic lidocaine. Patients need to be closely monitored for conduction abnormalities, arrhythmias, and heart failure.