Document Detail


Earlier diagnosis and treatment of acute myocardial infarction necessitates the need for a 'new diagnostic mind-set'.
MedLine Citation:
PMID:  8313577     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Triaging patients suspected of myocardial infarction is performed primarily in the coronary care unit, with infarction determined within 12 to 24 hours, and only about 20% are subsequently shown to have myocardial infarction. Plasma MB CK is not elevated until 8 to 10 hours after onset, and the ECG is unreliable; thus, the need has arisen for a new "diagnostic mind-set." The need is threefold: (1) more effective triaging in the emergency room to prevent unnecessary use of hospital beds, particularly those in the intensive care units, (2) to administer thrombolytic therapy in the early hours, and (3) earlier detection of coronary reocclusion and reinfarction. Diagnostic imaging techniques such as pyrophosphate, thallium-201 technetium sestamibi, or positron emitting agents lack the necessary early diagnostic specificity, but echocardiography has potential although its specificity is limited. Plasma CK isoforms provide diagnostic sensitivity and specificity of 96% and 94%, respectively, within the initial 4 to 6 hours of onset and can be assayed within minutes. In a prospective study of 1100 patients suspected of infarction, with conventional MB CK, 22% of the patients admitted to the coronary care unit would have had infarction, whereas using the CK isoforms, 75% had infarction and about 50% were discharged home. A scenario for the future might be to initiate thrombolytic therapy outside the hospital (eg, recombinant tissue-type plasminogen activator [r-TPA] 20 mg bolus) and upon arrival, confirm or exclude infarction by the MB CK isoform which can be performed in the emergency room in 20 minutes to determine whether thrombolytic therapy and heparin should be continued.
Authors:
R Roberts; N S Kleiman
Related Documents :
21385977 - Emergency cardiac surgery in patients with acute coronary syndromes: a review of the ev...
21332047 - The effects of radiofrequency ablation on left atrial systolic function in patients wit...
21394767 - Assessment of tissue edema in patients with acute myocardial infarction by computer-ass...
21241977 - Embolic renal infarct, patent foramen ovale and coronary artery dissection: a strange c...
3073767 - 7-oxo-pgi2 induced late appearing and long lasting antiischaemic and antiarrhythmic act...
4031307 - Echocardiographic recognition of paraseptal structures.
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  Circulation     Volume:  89     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1994 Feb 
Date Detail:
Created Date:  1994-03-18     Completed Date:  1994-03-18     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  872-81     Citation Subset:  AIM; IM    
Affiliation:
Baylor College of Medicine, Methodist Hospital, Houston, Tex. 77030.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Cardiology / methods*,  trends*
Chest Pain / diagnosis
Creatine Kinase / blood
Electrocardiography
Humans
Isoenzymes
Myocardial Infarction / diagnosis*,  therapy*
Myocardial Reperfusion
Myoglobin / analysis
Thrombolytic Therapy
Time Factors
Grant Support
ID/Acronym/Agency:
P50-HL42267-01/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Isoenzymes; 0/Myoglobin; EC 2.7.3.2/Creatine Kinase
Comments/Corrections
Comment In:
Circulation. 1994 Nov;90(5):2568   [PMID:  7955225 ]

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


Previous Document:  Visualization of penetrating transmural arteries in situ by monochromatic synchrotron radiation.
Next Document:  Relation of clinical presentation, stenosis morphology, and operator technique to the procedural res...