Left ventricular thrombi and cerebral embolism

Article Abstract:

Almost 15 percent of all cases of acute ischemic stroke (unconsciousness and paralysis brought on by interruption of the blood supply to the brain) are caused by embolism of cardiac origin, the interruption of cerebral blood flow due to the blockage of an artery in the brain by a fragment of clotted material which formed in the heart. Most of these emboli are the result of clot formation, thrombosis, in the heart following an acute myocardial infarction, or heart attack. Over a million survivors of heart attack are at risk of developing a blood clot, thrombus, which will result in cerebral embolism and stroke, especially within the first three months after a heart attack. There is evidence that the underlying physiological mechanism at work in embolization is propagation of the clotting process; that is, the surface of a newly-formed clot tends to result in the creation of an even bigger clotting surface, which eventually breaks up and forms emboli which are carried in the blood stream. Recent research supports the use of anticoagulant drugs such as heparin to mediate the process of clot formation. Nevertheless, several important issues remain to be settled: the proper type and dose of thrombolytic (clot-breaking) medication; the roles of echocardiography and other imaging techniques in selecting patients at high risk for embolism; and, the proper combination of aspirin (which helps prevent complications caused by coronary artery disease, such as heart attack) and anticoagulants (which protect against the development of clots in the ventricles of the heart).

Care and treatment, Complications and side effects, Thrombosis, Infarction, editorial, Cerebral embolism and thrombosis, Cerebral embolism, Cerebral thrombosis

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Coronary thrombolysis - a perspective for the practicing physician

Article Abstract:

Patients who have had a heart attack often receive thrombolytic therapy to prevent another heart attack. Thrombolytic therapy involves treatment with drugs to break up blood clots that may block the coronary arteries. The first clinical trial of thrombolytic therapy was carried out in 1959. Scientists lost interest in thrombolytic therapy for several years, but became interested again during the late 1970s. A research study found that treatment with 'accelerated' tissue plasminogen activator (t-PA) and heparin increased survival of heart attack patients more than treatment with streptokinase alone. These results conflict with those of two earlier research studies. The cost-effectiveness of widespread treatment with t-PA should be evaluated. Simultaneous treatment with other drugs such as aspirin and heparin should also be carefully evaluated. Both aspirin and heparin prevent the formation of blood clots.

Editorial, Usage, Drug therapy, Thrombolytic therapy

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Restrictive cardiomyopathy

Article Abstract:

Restrictive cardiomyopathy is a less common heart abnormality that may be caused by known and unknown factors. It is a disease of the heart muscle that causes impaired filling of the ventricle and normal or reduced ventricular diastolic volume. A diagnosis of restrictive cardiomyopathy should first rule out constrictive pericarditis, which can be treated surgically. Restrictive cardiomyopathy may be labelled more specifically as idiopathic, or arising from unknown causes, amyloid heart disease, endomyocardial fibrosis, or infiltrative disease. Treatments may include amiodarone to support sinus rhythm, warfarin for anticoagulation, and heart transplant surgery.

Case studies, Cardiomyopathy, Myocardial diseases, Heart enlargement, Heart hypertrophy

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