Management of acute myocardial infarction

Coronary heart disease (CHD) remains the single most common cause of death in the UK causing 22% of premature deaths in men and 12% in women. Most of these deaths are due to myocardial infarction (MI), of which there are 260,000 a year in the UK. The CHD death rate has decreased over the last 10 years, with a 37% reduction in premature deaths in those aged under 75 years old. More than one-half of this reduction is due to a decline in major risk factors (predominantly smoking cessation); with the rest due to individual treatments and secondary prevention. A significant improvement in survival can be made by prompt and appropriate intervention. Continued future improvements in the treatment of patients with MI will require a coordinated approach encompassing public education and a wide range of healthcare providers. This contribution considers the pathophysiology, clinical features and current management of acute MI. It includes a discussion about modern pharmacotherapy and the current reperfusion strategies of pre-hospital thrombolysis and primary angioplasty.