Changes in management of acute myocardial infarction over the last 110 years

The article by Hutchison et al. emphasises the modern approach to management of acute myocardial infarction (AMI). This is now an active management strategy, compared with the passive strategies of yesteryear. This starts with identification of early AMI by 12 lead ECGs performed by paramedic ambulance officers, and early treatment of symptoms or arrhythmias in the ambulance, coupled with early revascularisation by primary angioplasty/stenting (or thrombolysis if early transport to a cardiac catheter laboratory is not possible). Risk assessment early post myocardial infarction is the norm, with assessment of left ventricular function and risk of ventricular tachyarrhythmias ,as well as functional assessment of residual coronary artery disease,optimal evidence-based medical management, and a cardiac rehabilitation program, especially with an exercise component. Early return to normal activities, including work, is now encouraged as soon as two weeks after an ST elevation myocardial infarction.