A 48-year-old man with a history of hypertension was referred as an emergency to the local casualty department by his GP .He had developed central chest pain earlier in the day, which was gradually increasing in severity. Although he had initially thought that it might have been indigestion, he had called his GP when it d id not ease with antacids. On arrival to casualty, he was breathless and in pain. He was noted to be clammy and pale.His blood pressure was 190/110 and his heart rate was 105 and regular. The remainder of the clinical examination was normal.A12-lead ECG showed ST-segment elevation across the anterior chest leads, with left axis deviation and voltage criteria for left ventricular hypertrophy.
The diagnosis is acute anterior myocardial infarction.
The first consideration in the treatment of this patient is resuscitation: he should receive oxygen, and intravenous access will be established. He should initially be treated in the resuscitation area of casualty before transfer to the coronary care unit.Soluble aspirin(300mg) should be given with intravenous opiates for pain relief. At this point a decision needs to be taken with regard to his treatment: he can be treated with thrombolysis, in which case his blood pressure needs to be reduced to a safe level, or, if the facilities are available, he can undergo primary percutaneous coronary intervention.
