After undergoing repair of a left indirect inguinal hernia, a 72-year-old obese man is admitted to the emergency department with severe retrosternal pain of 1-hours duration. The pain radiates to the medial aspect of the left hand. The ECG shows Q waves and an elevated ST-segment. A diagnosis of acute MI is established 1 hour after admission. Immediate management should include which of the following?
Thrombolytic therapy with tissue plasminogen activator (tPA)
Vitamin K
Ampicillin, 2 mg tid PO
Hydrochlorothiazide, 50 mg/d
Thrombolytic therapy intravenously with streptokinase, urokinase, or tPA is indicated in most patients with MI presenting early for treatment. This therapy, however, is effective only if initiated within 6 hours after the onset of pain in patients with acute MI. These drugs are fibrinogenolytic, and aspirin and heparin are frequently included in the anticoagulant protocol. Reperfusion rates of 60% can be anticipated; reocclusion rates of 15% usually occur. Vitamin K is not indicated, because it would increase the coagulability of blood. If a diuretic, such as hydrochlorothiazide, 25-50 mg/d is indicated to treat milder hypertension, hypokalemia must be avoided.
Heart & Pericardium