Delays in the treatment of acute myocardial infarction: an overview

Article Abstract:

A heart attack, an acute myocardial infarction (AMI), occurs when blood vessels in the heart are obstructed. It is estimated that 90 percent of all AMIs are caused by blockage of the coronary arteries, which supply blood and oxygen to the heart muscle. Without oxygen, the affected portion of the heart muscle will begin to die. Therefore, it is critical to begin treatment as soon as possible after an AMI has occurred. Thrombolytic agents, such as streptokinase and tissue plasminogen activator, are drugs that dissolve blood clots. They are effective in reopening clogged blood vessels, thereby allowing normal blood flow to be restored. The goal in treating AMI is to restore blood flow as quickly as possible to minimize damage to the heart muscle. Emergency Medical Services (EMS) provide mobile intensive care and are widely used for heart attacks. It should be emphasized that EMS is not just a means of emergency transportation to the hospital. EMS paramedics may be able to prevent cardiac arrest in some cases of AMI. In the near future, it may become possible for EMS paramedics to begin thrombolytic therapy on the way to the hospital, thus saving precious time. In spite of these advantages, less than half of the patients with suspected AMI use EMS. It is estimated that the average delay between the onset of symptoms of AMI and patient arrival at the hospital is between two and four hours. On average, there is an additional 84 minute delay at the hospital before thrombolytic treatment is started. Patient registration, laboratory tests, physician consultation, obtaining thrombolytic agents from the pharmacy, and transferring the patient to the coronary care unit are activities that take time and delay treatment. Attempts should be made to educate the public about the hazards of delaying treatment. Efforts to reduce treatment delay at hospitals are also needed. Prompt treatment is important for better patient outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Emergency medical services

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Effects of relaxation and music therapy on patients in a coronary care unit with presumptive acute myocardial infarction

Article Abstract:

A heart attack, also called an acute myocardial infarction (AMI), is a potentially fatal event that if survived by a patient results in their admission to a coronary care unit. This is an extremely stressful event and the amount of stress can affect the patient's prognosis and recovery. The holistic approach to medicine recognizes this fact and attempts to reduce stress by a number of relaxation techniques. Many techniques are available, but little research has been done concerning their effectiveness. Benson's relaxation technique is a form of meditation in which the patient focuses on a word during the relaxation exercise. Music therapy is a potentially beneficial treatment for health problems including high blood pressure, migraine headaches, gastrointestinal ulcers, and cancer. A reduction in heart rates, pain, and an increased mood and peripheral temperature have been demonstrated in surgical and critical care patients who attended music therapy. A recent study determined the effectiveness of music and relaxation therapy against no therapy in reducing stress in 80 AMI patients. After attending three sessions in two days, patient stress was evaluated by heart rates, temperatures, heart complications, and the patient's own feelings about their stress. Those patients who received music or relaxation therapy had lower heart rates and higher peripheral temperatures than patients not receiving treatment. Patients receiving music or relaxation therapy had fewer cardiac complications and thought that the therapy was beneficial for their condition. It is concluded that music and relaxation therapy are effective in reducing stress in AMI patients and may aid in their prognosis and recovery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Stress (Physiology), Alternative medicine, Music therapy, Music

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Reperfusion and reperfusion injury in acute myocardial infarction

Article Abstract:

Heart attacks occur when the blood vessels that supply the heart muscle with oxygen become blocked. The blockage is a result of clots, fatty deposits from atherosclerosis, platelets (blood cells important in clotting) aggregation, and spasms of coronary arteries. Thrombolysis (destruction of clots), if done within six hours of a heart attack, can limit the severity of damage to the heart and allow reperfusion, or return of flow, to the coronary arteries. This article discusses how reperfusion can be accomplished and the complications that may accompany this procedure. The mechanisms by which reperfusion injuries occur are described. These include normal cell changes that take place in the absence of oxygen; cells undergo further reactions when circulation is repaired. Neutralization of free radical particles (highly charged oxygen ions) by superoxide dismutase, catalase, or mannitol appears to diminish reperfusion injury. A case study and a care plan are described. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reperfusion injury

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