Management of Anterior Myocardial Infarction

Initial Emergency Department Management

The American College of Cardiology recommends administering oxygen via nasal prongs immediately upon arrival to patients with anterior myocardial infarction 3
The American College of Cardiology suggests giving sublingual nitroglycerin unless systolic blood pressure is <90 mmHg or heart rate is <50 or >100 beats per minute to patients with anterior myocardial infarction 3
The American College of Cardiology recommends performing a 12-lead ECG within 10 minutes of arrival to confirm ST-segment elevation in anterior leads for patients with suspected anterior myocardial infarction 3
Establish continuous cardiac monitoring immediately with emergency resuscitation equipment readily available for patients with anterior myocardial infarction 2

The American College of Cardiology recommends evaluating for immediate reperfusion therapy if presenting within 12 hours of symptom onset for patients with anterior myocardial infarction 1
Consider primary PCI as the preferred reperfusion strategy if it can be performed within 90 minutes by skilled personnel with access to emergency CABG surgery for patients with anterior myocardial infarction 1
The American College of Cardiology suggests that the greatest benefit from thrombolysis occurs when administered within the first hour of symptom onset (35 lives saved per 1000 patients treated) for patients with anterior myocardial infarction 1

The American College of Cardiology recommends beginning intravenous nitroglycerin for 24-48 hours if no hypotension, bradycardia, or excessive tachycardia is present for patients with anterior myocardial infarction 2
Administer early intravenous beta-blocker therapy followed by oral therapy if no contraindications exist for patients with anterior myocardial infarction 2
Consider anticoagulation with intravenous heparin, particularly for patients with large anterior MI or LV mural thrombus seen on echocardiography, as they are at high risk for embolic stroke for patients with anterior myocardial infarction 4
The American College of Cardiology recommends avoiding prophylactic antiarrhythmic agents in the first 24 hours for patients with anterior myocardial infarction 2

The American College of Cardiology recommends continuing aspirin 160-325 mg daily indefinitely for patients with anterior myocardial infarction 2
Continue beta-blocker therapy for at least 6 weeks for patients with anterior myocardial infarction 2
Infuse nitroglycerin intravenously for 24-48 hours for patients with anterior myocardial infarction 2
Administer magnesium sulfate as needed to replete magnesium deficits for 24 hours for patients with anterior myocardial infarction 2
For patients who received alteplase (tPA), continue intravenous heparin for an additional 48 hours for patients with anterior myocardial infarction 2
Consider ACE inhibitors, particularly for patients with anterior MI or left ventricular dysfunction for patients with anterior myocardial infarction 4

Patients with anterior MI are at higher risk for left ventricular dysfunction and heart failure for patients with anterior myocardial infarction 2
Patients with anterior MI are at higher risk for LV mural thrombus formation and subsequent embolic stroke for patients with anterior myocardial infarction 4
Patients with anterior MI are at higher risk for conduction disturbances and arrhythmias for patients with anterior myocardial infarction 2
Perform echocardiography to evaluate LV function and detect potential complications such as mural thrombus for patients with anterior myocardial infarction 2
Limit physical activities for at least 12 hours after admission for patients with anterior myocardial infarction 2

Delaying reperfusion therapy beyond the golden first hour significantly reduces its effectiveness for patients with anterior myocardial infarction 3
Using oral nitrates instead of intravenous nitroglycerin in the acute phase, which prevents proper dose titration for patients with anterior myocardial infarction 2
Not having emergency equipment (atropine, lidocaine, pacing patches, defibrillator, epinephrine) immediately available for patients with anterior myocardial infarction 2
Administering calcium channel blockers, which have not been shown to reduce mortality and may be harmful for patients with anterior myocardial infarction 5