Expanding the use of thrombolytic therapy for acute myocardial infarction

Article Abstract:

Acute myocardial infarction (heart attack) is a condition that results from an acute blockage of the coronary arteries that supply the heart with blood. The resulting myocardial ischemia (insufficient blood supply to the heart) causes damage to and, if not treated immediately, death of portions of the heart muscle. It is recognized that the best initial treatment for acute myocardial infarction is thrombolytic therapy. This involves the administration of drugs (such as streptokinase or tissue plasminogen activator) that dissolve the clots, restoring blood flow to the heart. It is estimated that only about 10 percent of the patients eligible for this type of therapy actually receive it. It is important to find ways to increase the percentage of eligible patients receiving this potentially life-saving treatment. Review of the numerous large clinical trials that have been carried out in the 1980's, each of which has its own set of inclusion and exclusion criteria for determining which patients are eligible for thrombolytic therapy, allows certain conclusions to be drawn. All patients who meet currently agreed upon criteria for thrombolytic therapy should be given this treatment as soon as possible; this is not currently the case. The possibility of extensive bleeding as a complication of thrombolytic treatment does not appear to be as great as initially feared; the strict exclusion criteria for patients with conditions that might exacerbate bleeding could most likely be loosened without negative impact on patient well-being. Likewise, the implementation of a rigid upper age limit for thrombolytic therapy is not necessary. The exclusion of patients who have had symptoms for extended periods (e.g. over 12 hours) may be justified, but trials in progress will clarify this issue. The formulation of a clear and comprehensive plan for the inclusion and exclusion of patients for thrombolytic therapy is an important goal for hospitals and other providers of health care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Complications and side effects, Fibrinolytic agents, Thrombolytic drugs, editorial

---

Treatment-seeking behavior among those with signs and symptoms of acute myocardial infarction

Article Abstract:

Acute myocardial infarction (AMI), a heart attack, occurs when the blood vessels that carry blood to the heart muscle become blocked or clogged. This inhibits the normal flow of blood and cuts off the supply of oxygen to the affected portion of the heart muscle. Without oxygen, the heart muscle will begin to die. To minimize damage to the heart muscle and improve the chances of a full recovery, it is critical to begin treatment as soon as possible after the first symptoms of AMI begin. Delaying treatment for AMI increases morbidity and mortality. In many cases, the time delay between the onset of AMI and medical treatment is more than four hours. Factors that increase the delay include high blood pressure, diabetes mellitus, prior history of angina (chest pain), black race, older age, seeking advice from family members or a physician, and attempts at self-treatment. Factors that reduce the delay time include severe chest pain, younger age, and consultation with a friend or coworker. It appears that people who experience AMI for the second time are just as likely to delay before seeking medical treatment as those who experience symptoms of AMI for the first time. People who are most likely to delay before seeking medical treatment during AMI are those over the age of 65, blacks, and individuals with a history of chronic diseases; these patients should be educated about the hazards of delaying treatment. However, the results of a recent study performed in the state of Washington indicate that although public education programs are effective in increasing knowledge, they are not effective in altering behavior. In spite of public education programs, 40 percent of patients with AMI delay more than four hours before seeking treatment, and 50 percent do not use the emergency medical system. It may be more beneficial to educate family members so they can take charge in the event of an emergency, thereby helping the patient to seek treatment without delay. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Risk factors, Emergency medical services, Cardiovascular emergencies

---

The physician's role in minimizing prehospital delay in patients at high risk for acute myocardial infarction: recommendations from the National Heart Attack Alert Program

Article Abstract:

The National Heart Attack Alert Program makes the following recommendations to doctors to reduce delays in seeking treatment for heart attack in their patients. Clot-dissolving medication only helps when given shortly after symptoms appear. Patients and the families of patients at high risk for heart attack should be educated about the symptoms of a heart attack, what steps to take, and the importance of seeking hospital care. The information should be supplemented with written materials and reviewed frequently. Office staff such as receptionists should be instructed to refer patients with heart attack symptoms directly to the hospital.

Methods, Anticoagulants (Medicine), Anticoagulants, Dosage and administration, Emergency medicine

Similar abstracts:

• Abstracts: Coronary angiography and angioplasty after acute myocardial infarction. Delayed hospital presentation in patients who have had acute myocardial infarction
• Abstracts: Hemodynamically significant extrinsic left atrial compression by gastric structures in the mediastinum. Risk for clinical thromboembolism associated with conversion to sinus rhythm in patients with atrial fibrillation lasting less than 48 hours

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