title: Early intervention in acute myocardial infarction: one center's perspective.
abstract: Understanding of the phenomenon of acute myocardial infarction (AMI) and definition of proper treatment have changed radically in the past decade. AMI is regarded as an evolving event with an outcome that may be modifiable. Initial attempts at intervention involved reducing myocardial oxygen requirements and salvaging ischemic tissue. Studies of beta-blockade administration, which at first was considered contraindicated, have shown that such treatment may be beneficial and may also be safe in the postinfarction period. The hypothesis that the mass of infarct sustained is important to outcome is also under study, with use of such techniques as serial plasma creatine kinase (CK) determinations and ejection fraction for assessing infarct size. Analysis of isoforms of CK is a new area of interest that may facilitate early diagnosis and define the chronologic aspects of infarcts. Myocardial reperfusion with fibrolytic agents has yielded apparent benefit, but it is an aggressive and still experimental form of intervention. Positron tomography has been used for quantitative assessment of regional metabolism and perfusion. Initial results of reperfusion with clot-selective fibrinolytic agents, expected to reduce the risk of bleeding, indicate favorable effects on the heart and no evidence of systemic bleeding.
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000818:Animals; D004796:Clinical Enzyme Tests; D003402:Creatine Kinase / Q000097:blood; D004285:Dogs; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005730:Ganglionic Blockers / Q000627:therapeutic use; D006801:Humans; D007527:Isoenzymes; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D009206:Myocardium / Q000201:enzymology; D005996:Nitroglycerin / Q000627:therapeutic use; D010101:Oxygen Consumption / Q000187:drug effects; D010960:Plasminogen Activators / Q000627:therapeutic use; D011379:Prognosis; D011817:Rabbits; D013318:Stroke Volume; D013997:Time Factors; D014055:Tomography, Emission-Computed
chemical_list: D000319:Adrenergic beta-Antagonists; D005343:Fibrinolytic Agents; D005730:Ganglionic Blockers; D007527:Isoenzymes; D003402:Creatine Kinase; D010960:Plasminogen Activators; D005996:Nitroglycerin