Advances in the early diagnosis and management of acute myocardial infarction.

The effective early diagnosis of acute myocardial infarction still rests primarily on the clinical history and the electrocardiogram. ST segment elevation is specific though sometimes short lived and less than ideally sensitive; but with bundle branch block it defines a population that benefits importantly from thrombolysis. Novel electrode configurations can further enhance diagnosis but have not become popular. Biochemical markers are rarely of help in the first four hours and cardiac scanning is impractical for routine care. Computerised diagnostic systems show promise in prototype but are not widely available. Early management involves reestablishing coronary flow by thrombolytic and antithrombotic agents and reducing myocardial oxygen requirement by analgesics and beta blockers. Nitrates and magnesium have limited roles. Immediate access to defibrillation and advanced life support is mandatory. Diagnosis and management can only begin after help has been sought. Public alertness to the symptoms of myocardial infarction and a coordinated response by health care personnel are fundamental to successful care.