National Heart Attack Alert Program

The new treatments and the synergistic effect of time on their effectiveness, coupled with ongoing patient and system delays, gave the impetus for the National Heart, Lung, and Blood Institute's (NHLBI's) consideration, in the late 1980s, of establishing a national education program dedicated to coordinating efforts to improve emergency care for patients with acute MI and their outcomes (9). The NHLBI launched the National Heart Attack Alert Program (NHAAP) in June 1991, with the first meeting...

NonSTSegment Elevation Acute Coronary Syndromes

The history, physical examination, and baseline ECG all can be used to risk-stratify patients with non-ST-segment elevation acute coronary syndromes. Woodlief and colleagues developed a regression model in 1384 patients in the GUSTO-IIa trial that identified age, Killip class, systolic blood pressure, and previous hypertension as significant predictors of 30-d mortality (89). In 393 patients with unstable angina, Calvin and colleagues found previous infarction, lack of b-blocker or...

Dietary Factors

A possible link among atherosclerosis, thrombotic events, and dietary factors has been explored in several epidemiologic studies. The first, referred to as the Seven Country Study (153), observed a correlation between total calories consumed as saturated fats and the occurrence of coronary heart disease-related death. The potential direct impact of dietary factors on cardiac events was investigated in the Lyon Diet Heart Study (154). Patients with a prior MI were given a diet previously shown...

Obstructive Sleep Apnea

It is increasingly recognized that many adults have sleep disordered breathing patterns characterized as obstructive sleep apnea and hypopnea. There appears to be a high prevalence of these abnormalities in patients with cardiovascular disease, in the range of 30-50 (148). There is evidence that the disorder may increase the relative risks of myocardial infarction (149,150), sudden death (151), and cardiovascular death (152). One small study of 40 patients admitted with acute myocardial...

Expectations about Heart Attack Symptoms

REACT focus groups found that, overwhelmingly, participants expected that heart attack symptoms would correspond to common Hollywood movie portrayals as sharp crushing chest pain or collapse, such as a cardiac arrest. They thought there would be no doubt about the nature of the event that was occurring. This was in sharp contrast to the actual experience of heart attack symptoms described by participants (53). In addition to expecting a dramatic chest clutching presentation, knowledge of the...

Hormone Replacement Therapy

Hormone Replacement Progress

Postmenopausal hormone replacement therapy has been suggested to reduce cardiovascular morbidity by up to 56 in healthy women who take estrogen compared to women who have never taken hormone replacement medications (56) however, these observations from small clinical trials may overestimate the actual cardiovascular benefits derived from hormone replacement therapy (Fig. 6). Theoretically, estrogen supplementation may reduce coronary events by improving cholesterol profiles, promoting...

STElevation Myocardial Infarction Thrombolytic Therapy

While aggressive reperfusion therapy with pharmacologic agents has been shown to reduce in-hospital mortality by as much as 25-30 , women are more likely to have a contraindication to thrombolysis and, therefore, not receive thrombolytic therapy (122). This observation was confirmed in a series of1059 patients who presented with an acute myocardial infarction, which revealed that women were less likely to receive throm-bolytic agents than men (126). Moreover, it has been shown that only 55 of...

Specific Activities as Potential Triggers of Acute Myocardial Infarction

Trigger Worksheets For Mental Health

Morning and awakening appears to trigger acute coronary syndromes. Other environmental changes, such as the transition from weekend to work week and changes in weather cycles, may also function as triggers. Many investigators have sought specific events identifiable by patients as triggers. Studies using interview techniques to determine the fraction of patients reporting a suspected triggering activity in the time period immediately preceding the onset of symptoms have found that 25 to > 50...

Risk Stratification In Acute Coronary Syndromes

A possible explanation of the conflicting results in the above trials is the fact that patients with unstable angina and non-ST-elevation wave MI present with a wide spectrum of clinical risk for death and cardiac ischemic events. Ideally, one ought to be able to identify high risk patients who might benefit mostly from an aggressive invasive approach, and those with lower risk where conservative management might be more appropriate. Several analyses have been performed attempting to identify...

Comparative Trials of Thrombolytic Regimens

There are three large mortality trials comparing tPA with SK. These trials are summarized in Table 3 and discussed below 115 . GISSI-2 International Study Group Trial. The GISSI-2 International Study was the first adequately powered mortality study to compare tPA with SK and also to explore the Comparative Mortality Trials of tPA vs SK or APSAC GISSI-2 End Drug SK 3h tPA SK 3h tPA APSAC SK Accel. tPA SK tPA n patients 10,396 20,173 10,344 10,328 Death Reinfarction Any stroke Hemorrhagic stroke...

The Pathophysiology Of Cardiogenic Shock From Myocardial Infarction

A comprehensive understanding of the pathophysiologic characteristics and events of cardiogenic shock must be attained to impact the discouraging outcome of patients with this entity. The assiduous hemodynamic decline involves several interactive processes. Early initial 60 min in the course of infarction autonomic disturbances have a predominant influence on a patient's hemodynamic status. As reported by Webb et al. 8 sympathetic overactivity tachycardia and hypertension occurred in 36 of...

Allergy Hypotension Fever

SK and APSAC are antigenic and potentially allergenic although serious anaphylaxis and bronchoconstriction are rare incidence lt 0.2-0.5 96,103,104,110,118,160 . In ISIS-2, any allergic reaction was observed in 4.4 receiving SK compared to 0.9 receiving placebo, an absolute excess of 3.5 103 . In the comparative study ISIS-3 118 , any allergic-type reaction was reported after SK in 3.6 , APSAC in 5.1 , and tPA duteplase in 0.8 p lt 0.00001, SK vs tPA . Most of these reactions were minor only...

Anticoagulation Coagulation Cascade

Catalytic Site And Exosites Thrombin

Thrombin is a glycosylated serine protease that plays a fundamental role in thrombosis 117 . Thrombin is generated from prothrombin by the prothrombinase complex, which includes factors Xa, Va, calcium, and phospholipids Fig. 7 . Its main action is to transform fibrinogen into fibrin. Thrombin is one of the most potent endogenous platelet activator 110-112 . The active catalytic site lies within a relatively narrow canyon on the molecule's surface Fig. 8 118 . Adjacent to this site is the...

Early Clinical Risk Stratification

Timi Risk Stratification Score

The use of clinical and electrocardiogram ECG variables alone at the time of hospital admission in patients with ST-segment elevation myocardial infarction STEMI was examined in the InTIME II database of 14,114 patients treated within 4 h of symptom onset with lanoteplase nPA or tissue-type plasminogen activator tPA , aspirin, and heparin to predict 30-d mortality 2 . Ten independent variables accounting for 97 of the overall predictive capacity for increased 30-d mortality risk were included...

Introduction Of Myocardial Infarction

Pgi2 Cell Cycle

Fifteen years ago the Gruppo Italialono per lo Studio della Streptochianasi nell'Infarto Miocardico GISSI trial firmly established the benefit of fibrinolytic therapy in acute myocardial infarction 1 . Several years later, the importance of adjunctive antiplatelet therapy with aspirin was demonstrated in the Second International Study of Infarct Survival ISIS-2 2 . The need for concomitant anticoagulant therapy with heparin remains less clear, but indirect evidence in the setting of...