Acute myocardial infarction: Early treatment

Acute myocardial infarction is a common cause of death. Most of the deaths are due to ventricular fibrillation occurring soon after the onset of ischaemia. Once the patient reaches hospital, the major aim of treatment is to decrease the size of the infarct. Fibrinolytic therapy with streptokinase or tissue plasminogen activator (tPA) restores coronary patency and significantly reduces mortality. Aspirin is mandatory unless there are absolute contraindications to its use. Heparin is optional with streptokinase but necessary with tPA. ACE inhibitors and intravenous beta blockers are beneficial in acute myocardial infarction and intravenous glyceryl trinitrate probably has a role. Calcium channel blockers and magnesium should not be used routinely.