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Bolnik z akutnim miokardnim infarktom - ukrepi ob akutnem dogodku in ukrepanje v bolnišnici = Patient with acute myocardial infarction - treatment of an acute event and in-hospital treatment
Sinkovič, Andreja
Akutni miokardni infarkt (AMI) dokažemo klinično s povišanimi vrednostmi označevalca ishemične nekroze troponina I ali T skupaj s prsno bolečino ali spremembami v EKG ali dokazi za novo lokalizirano ...motnjo krčljivosti ali viabilnosti miokarda s slikovnimi preiskavnimi metodami. AMI vodi do izgube kontraktilne mase. Zato so po njem, zlasti z dvigom spojnice ST v EKG, pogosti zapleti, in sicer srčno popuščanje, aritmije, nenadna srčna smrt, in povečana umrljivost. Tako je pri AMI z dvigom ST nujno zgodnje prepoznavanje in ukrepanje že na terenu (MONA, heparin, klopidogrel) ter varen transport v interventni center zaradi zgodnjega reperfuzijskega zdravljenja. Bolnišnično zdravljenje obsega primarno perkutano koronarno intervencijo (PKI), kombinirano z antiagregacijskimi in antikoagulantnimi sredstvi. V prvih 2-3 urah je alternativa iv. fibrinoliza, če primarna PKI ni izvedljiva. Bolnišnično zdravljenje podaljšajo morebitni zapleti. Že v bolnišnici se prične sekundarna preventiva ateroskleroze s statini in zdravljenje z zaviralci konvertaze, ki preprečijo remodelacijo in s tem izboljšajo preživetje po AMI. Zbolevnost in umrljivosti po AMI, zlasti z dvigom ST, lahko zmanjšamo z zgodnjim reperfuzijskim zdravljenjem in zgodnjo uvedbo zaviralca konvertaze ter statina.
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