Why Internists Need to Be Able to Manage Patients with Myocardial Infarction

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Recently, I was asked to deliver a lecture for practicing internists reviewing the latest therapeutic interventions for patients with acute myocardial infarction. While preparing my presentation, I discussed the topic with some of my cardiology colleagues. Their comments usually included this idea: “Why should an internist know about the latest therapy for an acute myocardial infarction when almost all of these patients are going to be managed by a cardiologist?” This comment made me think about the role that an internist might be required to perform in this setting. Of course, most patients will be initially managed by a cardiologist, particularly if that patient needs an urgent trip to the catheterization laboratory. Eventually, I decided that there were 5 reasons why internists should be familiar with the management of patients with acute myocardial infarction.

First, internists are frequently involved in the initial and subsequent care of the myocardial infarction patient in both the in-patient and out-patient setting. Often, the internists are the first physicians to see patients with symptoms of acute myocardial infarction either in the office or in the emergency department. The internists must be familiar with the latest protocols for managing these complex, acutely ill patients.

Secondly, many patients with acute myocardial infarction are managed in-hospital by dedicated hospitalists, the overwhelming majority of whom are board-certified internists without additional subspecialty training. In many smaller hospitals, the hospitalist cares for the patient during his/her stay in the coronary care unit. Therefore, it is vital to the well-being of the patient with an acute myocardial infarction that the hospitalist/internist should be completely cognizant of the latest therapeutic strategies for this illness.

The third reason that internists need to be aware of state of the art therapy for acute myocardial infarction is that many internal medicine physicians serve on hospital executive committees or boards of trustees which must review and approve all standardized hospital protocols as well as standing orders for patients with a variety of acute and serious illnesses such as acute myocardial infarction. On many of these institutional administrative bodies, the internist will be the individual most knowledgeable concerning the pathophysiology, clinical presentation, and management of patients with acute myocardial infarction. In order for the internist to help these deliberating bodies understand the decision that they are about to make, the internal medicine member must be aware of the latest trends in the field of myocardial infarction.

Fourthly, in many communities in the United States, internists serve on public advisory boards for community emergency medical services. Often, they are the only physicians working on these committees. Protocols for urgent, “in the field” therapy, for patients with acute myocardial infarction are rapidly evolving. The internist members of these advisory boards must be aware of the latest therapeutic developments in the field of myocardial infarction if she/he is to give worthwhile advice to the community emergency medical services committee concerning protocols for rapid diagnosis and therapy of acute myocardial infarction.

Finally, the overwhelming majority of acute myocardial infarction patients will return to their primary care internists following the usually brief hospitalization. In the ambulatory setting, it is essential that the internists be fully cognizant of the latest therapeutic strategies for these patients. Patients as well as family members usually have questions that go unanswered during their short and often hectic in-patient stays. In addition, the importance of measures for secondary prevention of ischemic heart disease events cannot be overemphasized. Out-patient internists are responsible for ensuring that these preventive measures are instituted and continued. Although the acute care of patients with an acute myocardial infarction may be in the hands of cardiologists, these patients then almost always return to the care of an internist who must be able to implement the full range of secondary preventive measures.

Pondering these 5 reasons, I became convinced that internists must understand the causation, clinical presentation, and therapy of acute myocardial infarction. These physicians are vitally important to the teams caring for patients with this critical illness.