Diet preparation myocardial infarction
In the absence of high-risk indicators, an equal recommendation is given for an early conservative strategy or an early invasive strategy. Because nonadherence to medications is common in patients after a myocardial infarction and is associated with increased mortality risk, modifiable factors associated with medication self-discontinuation should be addressed before discharge. Early noninvasive stress testing is an important risk assessment tool, especially in patients who do not undergo revascularization. With an early invasive strategy, coronary angiography and revascularization are recommended within 48 hours in patients without contraindications. With an early conservative strategy, medical management is employed. Discharge medications should be continued to control ongoing symptoms (anti-ischemic agents) and prevent recurrent events (aspirin, clopidogrel, beta blocker, and an angiotensin-converting enzyme inhibitor or statins in selected patients). Early Hospital Care Noninvasive Testing Preparing for Discharge Postdischarge Interventions References Optimal management of myocardial infarction in the subacute period focuses on improving the discharge planning process, implementing therapies early to prevent recurrent myocardial infarction, and avoiding hospital readmission. Coronary angiography and revascularization are reserved for use in patients with evidence of ischemia at rest (or with minimal activity) and patients with a strongly positive stress test. This clinical content conforms to AAFP criteria for continuing medical education (CME). Antiplatelet therapy, renin-angiotensin-aldosterone system inhibitors, beta blockers, and statins constitute the foundation of medical therapy. MERCADO, MD, Naval Hospital Camp Pendleton Family Medicine Residency Program, Camp Pendleton, California DUSTIN K.
Discharge preparation should include a review of medications, referral for exercise-based cardiac rehabilitation, activity recommendations, education about lifestyle modification and recognition of cardiac symptoms, and a clear follow-up plan. Early Hospital Care Noninvasive Testing Preparing for Discharge Postdischarge Interventions References Article Sections. MCCONNON, MD, Naval Hospital Pensacola Family Medicine Residency Program, Pensacola, Florida Am Fam Physician. Evidence-based guidelines for the care of patients with acute coronary syndrome are not followed up to 25% of the time. Coronary Revascularization Hospital Discharge and Post-Hospital Care References Article Sections. Hospital discharge planning involves coordination of medical care, preparation of the patient for resumption of normal activities, and evaluation of the need for long-term risk factor reduction. Part II of this two-part article discusses coronary revascularization, hospital discharge, and post-hospital care. This period begins after a revascularization procedure has been performed or after the decision to not revascularize is made, and lasts for one to three months. SMITH, DO, U. Either percutaneous coronary intervention or coronary artery bypass grafting is considered suitable in patients with one- or two-vessel disease and none of the features mentioned above. The goals of coronary angiography are to provide information about prognosis based on the location and extent of coronary atherosclerosis and to identify the patients who will benefit from percutaneous or surgical revascularization. However, it should be noted that patients who initially are treated conservatively should be managed invasively if they develop high-risk indicators or have a strongly positive stress test before hospital discharge. S, Naval Hospital Guam, Agana Heights, Guam MICHAEL L.
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