Interventional coronary therapy in the elderly

Article Abstract:

When the technology for performing heart surgery was first developed, it was used mainly for treating young and middle-aged adults and was not recommended for the elderly. As surgical techniques improved, mortality associated with heart surgery began to decrease. In recent years, the number of elderly patients considered as candidates for heart surgery has been increasing. In 1967, the average age of a patient undergoing coronary artery bypass surgery at the Cleveland Clinic was 50 years. By 1986, the average age increased to 62 years, and 40 percent of the patients were over the age of 65. Old age is the greatest risk factor for morbidity and mortality following heart surgery. Older patients tend to have more severe heart conditions, such as angina (chest pain) or coronary artery obstruction. Also, older patients are more likely to have conditions such as diabetes, high blood pressure, or vascular disease. Emergency surgery and surgery for complications resulting from a heart attack are associated with high mortality among elderly patients. In contrast, mortality is low for elderly patients undergoing elective heart surgery. Percutaneous transluminal coronary angiography (PTCA) is a technique that is used to open clogged blood vessels in the heart. It involves inserting a catheter with an inflatable tip into the clogged artery. When the tip is inflated, the clogged artery is dilated. PTCA is an alternative treatment that offers several advantages over heart surgery, including shorter hospitalization, quicker return to daily activities, and lower cost. However, emergency PTCA is associated with high mortality in elderly patients. Although heart surgery and PTCA usually involve greater risks for the elderly compared with younger patients, these procedures can still provide significant benefits, such as relief from angina and increased longevity, to older patients as well. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Demographic aspects, Surgery, Myocardial revascularization, Heart, Coronary artery bypass, Transluminal angioplasty, Balloon angioplasty, Heart surgery

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Thrombolytic therapy in acute myocardial infarction

Article Abstract:

A heart attack (acute myocardial infarct) is a potentially fatal condition characterized by a decrease in the blood supply to the heart and results in the death of heart tissue. The blood supply is decreased because of the presence of blood clots (thrombi) or fatty plaques in the coronary vessels that supply blood to the heart. Agents that dissolve the thrombi and restore normal blood flow to the heart are used in the treatment of an acute myocardial infarct. A case was recently described of a 55-year-old white male who was brought to the emergency room by the fire department rescue team after awakening with chest pain that spread to his left shoulder. The patient's family had a long history of heart disease and he smoked one pack of cigarettes a day for the last 30 years. The patient received a drug that widens the coronary vessels called nitroglycerin, but this did not relieve his pain. He then received the narcotic morphine which gave immediate relief of his pain. The monitoring of the electrical activity of the heart indicated an acute myocardial infarct, and the patient was given aspirin and tissue plasminogen activator (t-PA), both of which act to dissolve thrombi. An initial dose of 6 milligrams (mg) of t-PA was administered, followed by periodic injections for a total of 100 mg of t-PA. The patient's condition stabilized, but six days later, recurrent chest pain developed and the electrical activity of his heart indicated another acute myocardial infarct. A small inflatable balloon was inserted into a vein, guided to the site of blockage, and inflated. This widened the coronary vessel and restored normal blood flow. The patient was discharged two days later and had no further symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Drug therapy, Dosage and administration, Tissue plasminogen activator

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Nonthrombolytic therapy for acute myocardial infarction

Article Abstract:

Myocardial infarction (heart attack) results when blood vessels supplying the heart muscle become blocked. Myocardial infarctions are responsible for one quarter of all deaths in the U.S.; death usually occurs within the first hour of the infarction onset. Improved cardiac care is responsible for a 40 percent decrease in deaths from myocardial infarction. Tissue plasminogen activator (TPA) and streptokinase, agents use to dissolve blood clots blocking coronary arteries, are given to improve blood circulation to the heart and preserve heart tissue. When TPA cannot be used, other methods to improve the blood flow to the heart must be employed. Medication is used to relieve pain and stress, and to reduce the oxygen requirements. A low-sodium diet and the use of beta blocking drugs may help reduce heart rate and blood pressure. Nitroglycerine can be give to patients to limit the heart infarct (area of affected tissue) size, eliminate chest pain, and help prevent potentially fatal abnormal heart rhythms, particularly rapid heart beats originating in the ventricle portion of the heart. Since 30 percent of hospital deaths occur during the late phase of a myocardial infarction, units which constantly monitor heart function should be used for early detection of abnormal heart rhythms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Sudden death, Arrhythmia

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