ACUTE MYOCARDIAL-INFARCTION - THEN AND NOW

Dramatic changes in the management of acute myocardial infarction (AMI ) have occurred in the past decade. While previous management strategi es were primarily supportive, current strategies focus on achieving an d maintaining patency of the infarct-related artery restoring blood no w to jeopardized myocytes, preserving left ventricular function, and p reventing recurrences and complications in addition to promoting heati ng. Restoration of blood flow can be achieved pharmacologically with t hrombolytic agents or mechanically with percutaneous transluminal coro nary angioplasty (PTCA). Early use of antiplatelet agents and anticoag ulants helps maintain patency of the infarct-related arteries and prev ents thromboembolic complications. Administration of beta-blockers and angiotensin enzyme inhibitors are more specific means of conserving m yocardium and preserving ventricular function. Additionally, several s trategies for preventing arrhythmias such as prophylactic lidocaine us e and routine long-term suppression of premature ventricular contracti ons with antiarrhythmic drugs are no longer routinely advocated. Basic ally, in the era prior to the eighth decade of this century, the prima ry direction of the therapeutic strategy for AMI was to reduce the oxy gen demands in the infarcted myocardium; whereas in the subsequent yea rs, the emphasis shifts to improvement in oxygen delivery via thrombol ysis, PTCA, and coronary artery bypass graft surgery. These interventi onal changes, when added to greater sophistication in the use of drugs to reduce oxygen demands, resulted in significant lowering of myocard ial mortality.