Bedside management of acute myocardial infarction

Management of AMI is greatly aided by appreciation of the consequent hemodynamic derangements, which produce the clinical signs of power failure. These can be assessed accurately at the bedside either by clinical evaluation or direct measurement using the pulmonary artery balloon catheter. This evaluation establishes both a short-term prognosis and a direction for therapy. Primary therapeutic alternatives include sedation, propranolol, diuretics, vasodilators, volume infusion, cardiac pacing, pressor agents, mechanical circulatory assistance, and emergency bypass surgery. From this formidable array of potential therapies, a reasonable and consistent choice can almost always be selected, based on our current knowledge of cardiac hemodynamics.