Coronary angiography after thrombolytic therapy for acute myocardial infarction

Article Abstract:

In recent years, the treatment of heart attacks has changed with the advent of thrombolysis, in which drugs that dissolve blood clots are given while a heart attack is occurring to break up the clot that has stopped the blood flow to the heart muscle. The studies and tests that are necessary and appropriate after thrombolysis are not yet clear. In the earliest trials, all patients who were given thrombolysis underwent coronary artery angiography, in which dye is injected into the arteries and X-rays are taken, to identify the blockages causing the heart attack. Many also had angioplasty, in which those blockages were opened by balloon catheters. When this early data was pooled and reviewed, early angiography or catheterization and angioplasty were not found to improve patient survival. A review of current data was undertaken to determine the role of angiography in the thrombolysis patient today. Occasionally, patients who are having heart attacks require emergency angiography, often followed by rescue angioplasty, which is done to open a blood vessel the thrombolytic agent has failed to open. Some require urgent catheterization, that is, an unplanned angiographic study done sometime during the hospitalization, for such reasons as recurrent chest pain or marked drops in blood pressure. The most controversial catheterizations are those which are done electively. Some clinicians would advocate angiography for all patients who have had thrombolysis. Angiography is expensive, it carries risks to the patient, and it is only available in about 20 percent of hospitals, requiring many patients to be transferred for the procedure. However, the information that may be gained from catheterizations may be invaluable in terms of assessing the patient's future risks. At present, there are no less invasive procedures providing useful information about future cardiac risk that are as accurate as angiography. However, studies have not yet demonstrated that those thrombolysis patients who undergo angiography have improved survival rates over those who do not. As noninvasive tests are further refined, angiography may play a smaller role in the follow-up care of thrombolysis patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Angiography

---

Guidelines for risk stratification after myocardial infarction

Article Abstract:

The American College of Physicians has released clinical guidelines for the treatment of heart attack. All patients with suspected heart attack should have a physical exam, a medical history and an electrocardiogram. The medical history will reveal any risk factors for heart attack. Patients with documented heart attack should be closely monitored for at least 48 hours. Those who have no complications can be discharged after 4 or 5 days. Those who have chest pain or arrhythmia may benefit from angioplasty or thrombolytic drugs. There is little evidence that aggressive diagnostic procedures are cost-effective in many patients.

---

Evidence-based coronary care

Article Abstract:

The care of patients who have had a heart attack will now depend on evidence gathered in clinical trials. The care of these patients has gone through several phases, culminating in high-tech treatment in coronary care units by a plethora of specialists. However, this approach is very expensive and the rise of managed care has forced many physicians to reconsider the approach. Studies are already finding that some patients do not benefit from aggressive diagnostic tests and probably should not receive them. The trick will be to identify groups of patients who will benefit most.

Editorial, History, Therapeutics

Similar abstracts:

• Abstracts: Interventional coronary therapy in the elderly. Thrombolytic therapy in acute myocardial infarction. Nonthrombolytic therapy for acute myocardial infarction
• Abstracts: Chronic diarrhoea after radiotherapy for gynaecological cancer: occurrence and aetiology. Investigation of seemingly pathogen-negative diarrhoea in patients infected with HIV1
• Abstracts: Cardiopulmonary toxicity after liposomal amphotericin B infusion. Airway inflammation
• Abstracts: Incidence and characteristics of preventable iatrogenic cardiac arrests. Clinical crossroads: an invitation
• Abstracts: Bone mineral density in premenopausal women receiving long-term physiological doses of levothyroxine. Addisonian crisis as presenting feature in malignancies

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.