Document Detail

Changing paradigms in thrombolysis in acute myocardial infarction.
MedLine Citation:
PMID:  9183037     Owner:  NLM     Status:  MEDLINE    
Acute myocardial infarction occurs when a ruptured coronary artery plaque causes sudden thrombotic occlusion of a coronary artery and cessation of coronary artery blood flow. This paper reviews the underlying coronary pathology in progressive coronary atherosclerosis, mechanisms of plaque rupture and arterial occlusion and the time relationship between coronary occlusion and myocardial necrosis. Reperfusion can be achieved by chemical thrombolysis with different thrombolytic agents. Early lysis is achieved best by prehospital administration, a transtelephonic monitor, a mobile intensive care unit, active general practitioner treatment or by warning the emergency room of impending arrival of a patient. Thrombolytic therapy may be unsuccessful and not achieve Grade III TIMI flow in less than 4 h (or even 2 h) due to inadequate or intermittent perfusion or reocclusion. Adjuvant therapy includes aspirin and platelet receptor antagonists. Bleeding is a constant danger. Direct percutaneous transluminal coronary angioplasty (PTCA) may be as effective or better than chemical thrombolysis. Reperfusion protects the myocardium and salvages viable tissue. It also improves mechanical remodelling of the ventricle. Long-term follow-up has shown that quantum leaps of fresh coronary occlusion causes step-wise progression in patient disability and that further early, prompt reperfusion can salvage myocardium and prevent this inexorable progress of the disease.
M S Gotsman; Y Rozenman; D Admon; M Mosseri; C Lotan; D Zahger; A T Weiss
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  International journal of cardiology     Volume:  59     ISSN:  0167-5273     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  1997 May 
Date Detail:
Created Date:  1997-07-31     Completed Date:  1997-07-31     Revised Date:  2006-07-12    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  IRELAND    
Other Details:
Languages:  eng     Pagination:  227-42     Citation Subset:  IM    
Department of Cardiology, Hadassah University Hospital, Jerusalem, Israel.
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MeSH Terms
Fibrinolytic Agents / therapeutic use*
Myocardial Infarction / diagnosis,  drug therapy*,  etiology
Myocardial Reperfusion / methods
Thrombolytic Therapy / methods*
Treatment Outcome
Reg. No./Substance:
0/Fibrinolytic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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