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CI, cardiac index (L/min/m ); SWI, stroke work index (g-m/m , calculated as [mean arterial pressure PCWP] stroke volume index 00136); PCWP, pulmonary capillary wedge pressure (in mm Hg; pulmonary artery diastolic pressure may be used instead); IABC, intra-aortic balloon counterpulsation

Echocardiography provides convenient bedside assessment of LV global and regional function This can help with the diagnosis and management of infarction; echocardiography has been used successfully to make judgments about admission and management of patients with suspected infarction, since normal wall motion makes an infarction unlikely Doppler echocardiography is probably the most convenient procedure for diagnosing postinfarction mitral regurgitation or VSD

in Table 10 6 Use of PA catheters, however, has generally not been associated with better outcomes and should be limited to patients with severe hemodynamic compromise

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An example of the Easy Access Menu for sales master data is shown in Figure 1-6 Naturally, there are thousands of such codes and it would be irrelevant to list them all However, if anyone is looking for a specific transaction code, a time-saving tip is to use [SE16n] with table TSTC (See 2 for information on [SE16] and [SE16n] (the data browser) and tables)

Alpert JS et al Myocardial infarction redefined a consensus document of The Joint European Society of Cardiology/ American College of Cardiology Committee for the redefinition of myocardial infarction J Am Coll Cardiol 2000 Sep;36(3):959 69 [PMID: 10987628] Ammann P et al Characteristics and prognosis of myocardial infarction in patients with normal coronary arteries Chest 2000 Feb;117(2):333 8 [PMID: 10669671] Zimetbaum PJ et al Current concepts Use of the electrocardiogram in acute myocardial infarction N Engl J Med 2003 Mar 6;348(10):933 40 [PMID: 12621138]

Technetium-99m pyrophosphate scintigraphy can be used to diagnose acute myocardial infarction When injected at least 18 hours postinfarction, the radiotracer complexes with calcium in necrotic myocardium to provide a hot spot image of the infarction This test is insensitive to small infarctions, and false-positive studies occur, so its use is limited to patients in whom the diagnosis by ECG and enzymes is not possible principally those who present several days after the event or have intraoperative infarctions Radiolabeled antimyosin antibody fragments are more sensitive and specific imaging agents, but scintigraphy must be performed 24 and 48 hours postinjection, so this test has limited clinical usefulness in the diagnosis of acute myocardial infarction Scintigraphy with thallium-201 or the newer technetiumbased perfusion tracers will demonstrate cold spots in regions of diminished perfusion, which usually represent infarction when the radiotracer is administered at rest, but abnormalities do not distinguish recent from old damage Radionuclide angiography demonstrates akinesis or dyskinesis in areas of infarction and also measures EF, which can be valuable RV dysfunction may indicate infarction of this chamber MRI with gadolinium contrast enhancement has emerged as one of the most sensitive tests to detect and quantitate extent of infarction

Table 10 4 provides a summary of the ACC/AHA Guideline recommendations for selected medical treatments

All patients with definite or suspected myocardial infarction should receive aspirin at a dose of 162 mg or 325 mg at once regardless of whether thrombolytic therapy is being considered or the patient has been taking aspirin Chewable aspirin provides more rapid blood levels Patients with a definite aspirin allergy should be treated with clopidogrel; a 300 mg (or 600 mg) loading dose will result in faster onset of action than the standard 75 mg dose Clopidogrel, in combination with aspirin, has also been shown to provide important benefits in patients with acute ST elevation myocardial infarction In the CLARITY trial, a loading dose of 300 mg of clopidogrel given with thrombolytic therapy, followed by 75 mg a day, led to substantial improvement in coronary patency on catheterization 35 days following thrombolysis Moreover, there was no increase in serious bleeding in this population of patients up to 75 years of age The COMMIT/CCS-2 trial randomized over 45,000 patients in China with acute myocardial infarction to clopidogrel 75 mg a day or placebo, and found a small but statistically significant reduction in early death,

These can be helpful in managing the patient with suspected cardiogenic shock Their use is described below and

myocardial reinfarction, and stroke, with no excess in major bleeding For patients who have received thrombolytic therapy but will undergo angiography in the first day or two, the early benefits of clopidogrel need to be weighed against the need to delay bypass surgery for approximately 5 days for those patients found to require surgical revascularization

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