Dealing with myocardial infarction (HAS)

The French SAMU, the Francophone Society for Medical Emergency and the French Society of Cardiology designed, in partnership with Haute Autorité de Santé (HAS), a series of recommendations to deal with the acute phase of myocardial infarction away from cardiology units. The latest recommendations were published in April 2007.

Decisional criteria for prescribing coronary obstructions clearing for an acute infarction

According to the HAS, prescription lies on a Bayesian procedure type, described by the following diagram:

Reperfusion strategies and adjuvant treatments to be implemented for an acute coronary syndrome ST+

Perfusion strategy

HAS recommends "the decrease of the time between the begining of the symptomatology untill coronary repermeabilisation", focusing on the fact that the international global deadline between the first medical contact and the cuff expansion, is of 90 minutes.

HAS states that "reperfusion strategies lie on the coronary angioplasty and fibrinolysis" and summerises the choice of strategy through this diagram.

Adjuvant treatments

HAS lists these treatments ( acetylsalicylic acid, clopidogrel, antagonists of the GPIIb/IIIa receivers, anticoagulants, nitrated derivatives, oxygen therapy, antalgics, beta adrenergic blocking agent, inhibitors of conversion enzyme and calcic antagonists, insulin) and points out if they are recommended or not, when and how to use them (see pages 6 and 7 of the HAS report).

Characteristics of dealing with a patient suffering from a chest pain referring to an acute myocardial infarction

"Prescribe 15": HAS insists on this objective. Patient's steps, putting him in contact with a health professional and the means undertaken to intervene are summarised in the following diagram:

Particular situations in dealing with acute infarction

HAS states in pages 8 and 9 of the document published by HAS, how to deal with:
  • elderly people,
  • diabetic patients,
  • infarction in a non cardiology care unit,
  • perioperative infarction .

Dealing with initial complications

For bradycardia

  • Electrocardioscopic supervision only.
  • External electrosystolic training.
  • Pharmacological treatment.

For tachycardia

HAS summarises how to deal with it in this diagram :

For circulatory arrest (CA), cardiogenic shock, inter-hospital transfer of complex infarction

Refer to page 11 of the document published by HAS.


Consult recommendations, short and long version, of the consensus conference , published by HAS.

Photographic copyright: Tomasz Trojanowski -
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