Myocardial infarction: the first 24 hours

Myocardial infarction is the most common cause of death in the United States. Rapid postinfarction intervention in the first 24 hours decreases mortality. Treatment modalities are rapidly evolving as new data from basic science research and clinical trials become available. Rapid thrombolysis, accurate criteria for diagnosis and administration of effective adjunctive therapy are crucial in preventing complications of myocardial infarction. Initial measures in the emergency department include intravenous access, accurate history and physical assessment, placement of oxygen, electrocardiography, use of aspirin and nitrates, and consideration of thrombolysis or angioplasty in appropriate candidates, optimally within one to two hours of myocardial infarction. After hospital admission, additional adjunctive treatment, including beta blockers, angiotensin-converting enzyme inhibitors and anticoagulation, can be instituted.