Table 4 Management differences between TC and AMI
TC | AMI | |
|---|---|---|
9. Evolution and management | ||
Evolution | ||
Symptoms relieve | Complete after LV function recovery | Depends on LV function, ongoing ischemia, multivessel CAD, complete/incomplete revascularization |
ECG | Normalize | AMI sequelae (Q waves), persistent T wave inversion, and persistent ST-segment elevation may appear |
Echocardiography | LV function complete recovery, wall motion abnormalities remission | LV function complete/incomplete recovery, persistent/worse LV dysfunction |
Treatment | ||
Acute phase complications | ||
Acute heart failure/pulmonary edema | Intravenous diuretics, nitrates (if LVOTO is absent) | Intravenous diuretics, nitrates |
Cardiogenic shock | LV assist device, venous to arterial extracorporeal membrane oxygenation AVOID: inotropes- epinephrine, norepinephrine, dobutamine, milrinone, isoprenaline | -LV assist device, venous to arterial extracorporeal membrane oxygenation -Inotropes-epinephrine, norepinephrine, dobutamine, milrinone, isoprenaline on short term |
LVOTO | Beta-blockers, intravenous fluids in the absence of acute heart failure AVOID: diuretics, nitrates, intra-aortic balloon pump | – |
Arrhythmias | Ventricular arrhythmias: beta blockers, magnesium sulfate, electrical cardioversion; AVOID QT-prolonging drugs High degree atrioventricular block: temporary pacing; AVOID: permanent pacing, beta-blockers | Ventricular arrhythmias: beta blockers, magnesium sulfate, amiodarone, lidocaine, electrical cardioversion High degree atrioventricular block: temporary pacing |
LV thrombus | Anticoagulation for at least 3 months | Anticoagulation for at least 3 months |
In-hospital/at discharge | ||
Antiplatelets | − | + |
Statins | + | + |
Beta-blockers | + | + |
ACEI | + | + |
ARBs | ± | + |
Mineralocorticoid inhibitors | ± (if LVEF< 40%) | ± (if LVEF< 40%) |
Diuretics | ± (if heart failure symptoms) | ± (if heart failure symptoms) |
Digoxin | − | − |
Nitrates | − | ± (antianginal effect) |
Antiarrhythmic drugs | Beta-blockers, ivabradine AVOID: QT prolongation drugs | Beta-blockers, amiodarone |
1.Prognosis | ||
Usually benign, but severe complications may occur | Reserved | |