Acute Myocardial Infarction -- Printable Tables

TITLE:	Acute Myocardial Infarction
AUTHOR:	CHRISTOPER T. BAJZER MD -- Department of Cardiology, The Cleveland Clinic
PUBLISHED:	MAY 30, 2002

Table 1:

Signs and Symptoms of a Myocardial Infarction

Chest pain described as a pressure sensation, fullness, or squeezing in the midportion of the thorax
Radiation of chest pain into the jaw/teeth, shoulder, arm, and/or back
Associated dyspnea or shortness of breath
Associated epigastric discomfort with or without nausea and vomiting
Associated diaphoresis or sweating
Syncope or near-syncope without other cause
Impairment of cognitive function without other cause

Table 2:
Normal Values of Blood Tests to Detect Myocardial Infarction
Analysis	Normal Range
Total creatinine phosphokinase (CPK)	30-200 U/L
CPK, MB fraction	0.0-8.8 ng/mL
CPK, MB fraction percent of total CPK	0-4%
CPK, MB2 fraction	< 1 U/L
Troponin I	0.0-0.4 ng/mL
Troponin T	0.0-0.1 ng/mL

Table 3:
Nitroglycerine Dosing Schedule in Myocardial Infarction
Nitroglycerine Formulation	Dosing
Sublingual tablet	0.2-0.6 mg every 5 minutes
Spray	0.4 mg every 5 minutes
Transdermal or paste	0.2-0.8 mg/hour
Intravenous	5.0-200 mcg/minute

Table 4:
Selective Beta-1-blockers
Beta-1-blocker	Dosing
Metoprolol	25-200 mg every 12 hours
Atenolol	25-200 mg every 24 hours
Esmolol	50-300 mcg/kg/minute intravenously
Betaxolol	5-20 mg every 24 hours
Bisoprolol	5-20 mg every 24 hours
Acebutolol	200-600 mg every 12 hours

Table 5:
Heparin Dosing
Heparin Agent	Dosing
Unfractionated heparin	60-70 units/kg intravenous load (maximum 5000 units) 12-15 units/kg/hour intravenous maintenance drip Nomogram titrate to maintain aPTT 1.5-2.5 x control
Enoxaparin	1 mg/kg subcutaneous every 12 h
Dalteparin	120 IU/kg subcutaneous every 12 h (maximum 10,000 IU in 24 h)

Table 6:
Fibrinolytic Therapy for Myocardial Infarction
Agent	Trade Name	Dosing	Patency @ 90 minutes
Alteplase	Activase	Body weight > 67 kg 15 mg load + 50 mg/30 min + 35 mg/60 min intravenously Body weight < 67 kg 15 mg load + 0.75 mg/kg/30 min (< 50 mg total) + 0.5 mg/kg/60 min (< 35 mg total)	75%
Reteplase	Retavase	10 units/2 minutes + wait 30 minutes + 10 units/2 minutes intravenously	75%
Streptokinase	Streptase	1.5 million units/60 minutes intravenously	50%

Table 7:
Glycoprotein Ilb/IIa Inhibitors
Agent	Use	Dosing
Abciximab	Coronary intervention	0.25 mg/kg intravenous load 0.125 mcg/kg/min intravenous maintenance (maximum 10 mcg/min) duration of infusion 12-24 h
Eptifibatide	Acute coronary syndrome Coronary intervention	180 mcg/kg intravenous load 2.0 mcg/kg/min intravenous maintenance duration of infusion up to 72 h
Tirofiban	Acute coronary syndrome Coronary intervention	0.4 mcg/kg/min x 30 min intravenous load 0.1 mcg/kg/min intravenous maintenance duration of infusion 12-24 h

Table 8:
Angiotension Converting Enzyme Inhibitors
Agent	Divided	Dosing
Captopril	2 or 3 times daily	12.5-450 mg/day
Enalapril	once or twice daily	2.5-40 mg/day
Moexipril	once or twice daily	7.5-30 mg/day
Benazapril	once or twice daily	5-40 mg/day
Quinapril	once or twice daily	5-80 mg/day
Ramipril	once or twice daily	2.5-20 mg/day
Perindopril	once or twice daily	4-16 mg/day
Trandolapril	once daily	1-4 mg/day
Fosinopril	once daily	10-40 mg/day
Lisinopril	once daily	2.5-40 mg/day

Table 9:
Lipid Lowering Agents
Agent	Dosing
Clofibrate	500 mg four times daily
Fenofibrate	54-160 mg once daily
Gemfibrozil	600 mg twice daily
Lovastatin	10-80 mg once daily
Simvastatin	5-80 mg once daily
Fluvastatin	20-80 mg once daily
Pravastatin	10-80 mg once daily
Atorvastatin	5-80 mg once daily
Colesevelam	625 mg three to seven tablets daily
Colestipol	1 gm tablets; 2-16 gm/day 5 gm granule packets; 5-30 gm/day
Cholestyramine	4-24 gm daily; divided doses
Niacin	500 mg-2 gm daily; divided doses

This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.

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