Reducing mortality in patients with extensive myocardial infarction

Article Abstract:

Information is presented concerning recently developed approaches to improving mortality after severe myocardial infarction (heart attack). An article in the October 17, 1991 issue of The New England Journal of Medicine reports that cardiogenic shock, an often-fatal condition in which systemic shock results from the sudden decrease in cardiac output, occurred in 7 to 8 percent of the 4,000 heart attack patients studied, with mortality as high as 82 percent. Patients most likely to develop cardiogenic shock are those with a prior history of myocardial infarction or severe disease of the coronary arteries; such patients should have the blood flow in their coronary arteries restored as rapidly as possible. Treatments such as thrombolytic (clot-dissolving) drug therapy, percutaneous transluminal coronary angioplasty (PTCA; enlarging the narrowed or occluded vessel), or surgical procedures to replace the damaged vessels (revascularization or bypass grafting) may be effective if carried out promptly. Thrombolytic therapy can reopen arteries within 40 to 80 minutes. Immediately after receiving thrombolytic therapy, patients with signs of cardiogenic shock should undergo cardiac catheterization (insertion of a fine tube into the heart by way of a large vein to detect heart abnormalities). When symptoms have been present for a long period, patients often benefit temporarily from an intraaortic balloon pump (which is inserted into the aorta and helps pump blood). Since shock often recurs when the balloon pump is removed, surgical revascularization should be carried out at that time. Other more powerful devices for assisting circulation have been developed; these are described. Some function well for weeks or even months until a heart donor is found. However, donors are in extremely short supply and waiting lists are very long. In 1990, more than 600 patients died waiting for heart transplants. In addition to developing better circulatory-assist devices, another goal is to design left ventricular-assist systems that can eliminate the need for heart transplantation altogether in many cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Cardiogenic shock, editorial

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Thrombolysis in acute myocardial infarction

Article Abstract:

Patients who have have had a heart attack often receive thrombolytic therapy. Thrombolytic therapy involves treatment with drugs to break up blood clots. Most heart attacks are caused by sudden blockage of the coronary artery. This type of blockage is usually caused by a blood clot or a ruptured atherosclerotic fat deposit. Thrombolytic drugs that are commercially available include streptokinase, anistreplase, urokinase and tissue plasminogen activator. Patients who receive thrombolytic therapy may also receive simultaneous treatment with other drugs. Treatment with aspirin inhibits the activity of blood platelets. Heparin is used to block the activity of different blood coagulation factors. Patients who receive thrombolytic therapy may have a higher risk of bleeding episodes. Heart attack patients must be under 75 years old to be eligible for thrombolytic therapy. They should also have chest pains lasting between 30 minutes and six hours and certain characteristics on an electrocardiogram.

Drug therapy, Thrombolytic therapy

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Use of a continuous-flow device in patients awaiting heart transplantation

Article Abstract:

Results from a large observational clinical study of a continuous-flow left ventricular assist device are presented.

Medical Instruments and Supplies, Surgical and Medical Instrument Manufacturing, Cardiac Assist Pumps, Health aspects, Heart, Heart transplantation, Heart assist devices, Clinical report

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