Preventive strategies in management of acute myocardial infarction

Abstract

Recent studies on pathogenetic mechanisms, supplemented by findings in clinical trials point the way to a logical approach to acute evolving myocardial infarction. This is designed in the earliest stage to limit infarction through reduction in myocardial oxygen demands, improvement in collateral blood supply and dissolution of coronary thrombus, to prevent in a later stage coronary reocclusion through administration of antiplatelet agents, and then to prevent infarct expansion through reduction in ventricular wall tension throughout the period of repair. Application of such an approach holds the promise of reducing infarct size and all the complications of infarction, as well as short and long-term mortality. The approach is active and aggressive, and contrasts with the approach applied a decade ago, where infarction was accepted as inevitable and therapies were reserved for managing its complications.

Volatile anaesthetics reduce adhesion of blood platelets under low‐flow conditions in the coronary system of isolated guinea pig hearts

“…0 Acta Anaesthesiologica Scandinnziica 42 (1 9981 HE INCIDENCE of myocardial ischaemia and infarc-T tion during the perioperative period is high in patients at risk (1). Of particular interest is the observation that perioperative myocardial infarction is frequently a result of coronary artery thrombosis (2), in which platelets play an essential role. This was demonstrated in studies dealing with percutaneous transluminal coronary angioplasty (3)(4)(5) and by the successful clinical testing of newly developed "anti-platelet" drugs, such as fibrinogen antagonists, monoclonal antibodies against GPIIb/IIIa and platelet ADP-receptor inhibitors (6)(7)(8)(9).…”

The Effect of Anaesthetic Agents on Platelet Function

“…No effect § 1.6 30% inhibition (P < 0.025) §Halothane may have evaporated during preparation of samples 43 cerebrovascular or coronary artery disease.4-8 Of particular importance is the recognition that myocardial infarction is frequently a result of coronary artery thrombosis, and is not always precipitated by an imbalance in myocardial oxygen supply and demand. 67 This has implications for anaesthetists, because in the management of patients with coronary artery or cerebrovascular disease it may be important to continue 'anti-platelet' therapy through the peri-operative period. Moreover, it is possible that anaesthetic agents that have 'anti-platelet' effects protect against intravascular thrombosis during surgery.…”