Acute Infarct Management

Initial Assessment and Stabilization

The American College of Cardiology recommends performing rapid evaluation within 10 minutes of arrival to the emergency department, with no more than 20 minutes elapsing before assessment is complete 1
The American Heart Association recommends immediately initiating cardiac monitoring to identify potential cardiac conditions such as acute myocardial infarction, atrial fibrillation, or heart failure 2
The European Society of Cardiology recommends providing supplemental oxygen therapy for patients with arterial oxygen saturation <90% 3
The American Heart Association recommends positioning the head of the bed at 25-30° to manage potential increased intracranial pressure until large lesions or other causes of increased ICP are ruled out 2
The American Heart Association recommends obtaining vital signs frequently, at least every 30 minutes while in the emergency department 2
The American Heart Association recommends treating hyperthermia (temperature >99.6°F) with acetaminophen as it is associated with poor outcomes 2

The American College of Cardiology recommends performing a 12-lead ECG to rule out cardiac causes and identify patients with ST-segment elevation or left bundle branch block who may need cardiac reperfusion therapy 1
The European Society of Cardiology recommends considering emergency echocardiography if the diagnosis is uncertain, but do not delay angiography if indicated 3
The American Heart Association recommends determining whether the stroke is an ischemic infarction or intracranial hemorrhage through brain imaging 2

The American College of Cardiology recommends considering immediate reperfusion therapy with either thrombolysis or primary percutaneous coronary intervention for patients with acute myocardial infarction and ST-segment elevation (≥1 mm) in contiguous leads 1

The American College of Cardiology recommends administering aspirin 160-325 mg orally immediately for suspected myocardial infarction 1
The American College of Cardiology recommends giving sublingual nitroglycerin for suspected myocardial infarction (unless systolic BP <90 mmHg or heart rate <50 or >100 bpm) 1
The American College of Cardiology recommends providing adequate analgesia with morphine sulfate or meperidine for myocardial infarction 1
The American Heart Association recommends monitoring neurological status and vital signs every 15 minutes during infusion, every 30 minutes for 6 hours, then hourly until 24 hours after treatment for ischemic stroke patients receiving tPA 2

The American Heart Association recommends notifying physician for systolic BP >220 mmHg or <110 mmHg, diastolic BP >120 mmHg or <60 mmHg for ischemic stroke patients not receiving thrombolysis 2
The American Heart Association recommends maintaining blood pressure below 180/105 mmHg for patients receiving thrombolytic therapy 2
The European Society of Cardiology recommends that optimal blood pressure targets should be individualized based on the patient's baseline values for myocardial infarction patients 3

The European Society of Cardiology recommends considering glucose-lowering therapy while avoiding hypoglycemia for patients with hyperglycemia (glucose >10 mmol/L or >180 mg/dL) 6
The European Society of Cardiology recommends carefully monitoring renal function for at least 3 days after coronary angiography/PCI in patients on metformin and/or SGLT2 inhibitors 3