Emergency medicine has taken a significant step forward with the recent publication in The American Journal of Emergency Medicine, authored by Davis William T., Montrief Tim, Koyfman Alex, and Long Brit. Their review article, titled “Dysrhythmias and heart failure complicating acute myocardial infarction: An emergency medicine review,” provides invaluable insights into the complications that can arise following an acute myocardial infarction (AMI), particularly focusing on dysrhythmias and heart failure (HF). The DOI for this article is 10.1016/j.ajem.2019.04.047.
Patients who have experienced an AMI are at a heightened risk for numerous complications that can increase both morbidity and mortality rates. This narrative review carefully evaluates existing literature and guidelines concerning the immediate emergency department (ED) management of AMI when it is complicated by dysrhythmia or HF, specifically emphasizing evidence-based considerations for emergency interventions.
The complications of dysrhythmias and HF post-AMI are not only medical challenges but also areas requiring further research. The article points out that the limited evidence for in-depth management of dysrhythmias is due to a relatively low prevalence and the frequent exclusion of patients with active cardiac ischemia from clinical studies.
When it comes to the management of bradycardia in the setting of AMI, decisions have to be made considering the location of the infarction, timing of the dysrhythmia, rhythm assessment, and the patient’s hemodynamic status. Meanwhile, atrial fibrillation, which is common during AMI, requires careful consideration—particularly regarding acute rate control in light of a rapid ventricular rate that may compensate for decreased ventricular function.
The article specifies that a regular wide complex tachycardia in the context of AMI should generally be managed as ventricular tachycardia, with electrocardioversion preferred in most scenarios. As for HF management, especially stemming from left ventricular dysfunction post-AMI, the recommendations include noninvasive positive pressure ventilation, nitroglycerin therapy, and prompt cardiac catheterization.
For patients presenting with cardiogenic shock and clinical signs of hypoperfusion, norepinephrine is identified as the first-line vasopressor. The authors emphasize the importance of early involvement from a multi-disciplinary team when attending to patients in cardiogenic shock.
This comprehensive review discusses the various considerations that emergency medicine physicians should take into account when managing dysrhythmias and HF associated with AMI. It is a timely reminder of the complexities involved in post-AMI care and the critical decisions that can influence patient outcomes.
Published by Elsevier Inc., the review serves as a crucial resource for emergency medicine professionals seeking to update their clinical practice with the latest evidence-based guidelines.
1. Davis William T, Montrief Tim, Koyfman Alex, Long Brit. Dysrhythmias and heart failure complicating acute myocardial infarction: An emergency medicine review. Am J Emerg Med. 2019 Aug;37(8):1554-1561. doi: 10.1016/j.ajem.2019.04.047.
2. Am J Emerg Med. 2019 Aug;37(8):1592. doi: 10.1016/j.ajem.2019.05.004.
3. Am J Emerg Med. 2019 Aug;37(8):1591-1592. doi: 10.1016/j.ajem.2019.05.029.
4. Practice Guidelines as Topic.
5. Randomized Controlled Trials as Topic.
1. Acute myocardial infarction emergency
2. Dysrhythmia management AMI
3. Heart failure post-AMI
4. Emergency department cardiogenic shock
5. Ventricular tachycardia AMI treatment
The American Journal of Emergency Medicine’s recently published review article delves into one of the most complex areas of post-AMI management—handling dysrhythmias and HF. With detailed evaluations and guidelines, this research is indispensable for professionals striving to provide top-tier emergency care for patients grappling with the repercussions of a myocardial infarction. As medical science progresses, such nuanced reviews remain pivotal in reducing complications and improving patient outcomes following an AMI.