Acute myocardial infarction: initial manifestations, management, and prognosis

In patients with suspected acute myocardial infarction (AMI), obtaining a thorough history is important for identifying both the cause of chest pain and any concurrent conditions that may complicate the management. Physical examination--including cardiac auscultation and determining the status of the peripheral vasculature--is important as a guide to immediate management and as a baseline for future comparison. The differential diagnosis of AMI is extensive, and various laboratory tests, such as electrocardiography, cardiac enzymes, radionuclide techniques, echocardiography, and cardiac catheterization, can aid in the diagnosis. The routine management of patients with AMI can include medical therapy with antithrombotic agents, nitrates, beta-adrenergic blockers, or calcium channel blocking agents. The major differences between Q-wave and non-Q-wave infarction are discussed. Some factors that affect early and late prognosis in patients with AMI are age of the patient, residual left ventricular function, residual myocardial ischemia, and substrates for sustained ventricular arrhythmias. Although much of the current enthusiasm in management of AMI is related to revascularization strategies, other important aspects of diagnosis and treatment should not be overlooked.