Management of acute myocardial infarction in the public sector in the Bahamas

In 1996 and 1997, 52 patients were admitted to the Princess Margaret Hospit al, Nassau, Bahamas, with a confirmed diagnosis of acute myocardial infarct ion (AMI). The average time to presentation after the onset of symptoms was 18 hours, with 56% of patients presenting within 12 hours. Risk factors id entified for ischaemic heart disease were hypertension (77%), obesity (62%) , diabetes mellitus (35%), tobacco smoking (25%), a family history of coron ary artery disease (17%) and hypercholesterolaemia (8%). Medications admini stered in the treatment of AMI included oral nitrates (96%), intravenous he parin (90%), beta-blockers (65%), morphine (15%), thrombolytic agents (8%) and lignocaine (4%). In hospital post myocardial infarction complications w ere angina (23%), arrhythmias (12%) and cardiac failure (10%). The average hospital stay was eight days, with a mortality rate of 19%. These results s how that there is considerable room for improvement, particularly in the us e of thrombolytic therapy, to ensure that all patients receive optimal acut e and post myocardial infarction care.