What Is the Treatment for a Myocardial Infarction?

Thrombolytic therapy for acute myocardial infarction, the route of administration is intracoronary thrombolysis and intravenous thrombolysis.

Thrombolytic therapy for acute myocardial infarction

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Thrombolytic therapy for acute myocardial infarction, the route of administration is intracoronary thrombolysis and intravenous thrombolysis.

Chinese name

Thrombolytic therapy for acute myocardial infarction

Medication route

Intracoronary thrombolysis and intravenous thrombolysis

Efficient

50% to 90%

Sufferer

Myocardial infarction

Thrombolytic indication

Persistent chest pain half an hour

The formation and development of acute myocardial infarction are affected by thrombotic factors. Some patients may form thrombi on the basis of coronary atherosclerosis, which can cause coronary occlusion and myocardial infarction. Some patients may be due to persistent coronary spasm Myocardial infarction occurs, and thrombus is formed on this basis, thereby expanding the scope of myocardial infarction.

At present, the cause of death in patients with myocardial infarction is mostly due to pump failure or fatal arrhythmias associated with it or

It is a thrombolytic treatment method, that is, in the early stage of acute myocardial infarction, a drug with a thrombolytic effect is used to dissolve the thrombus, reopen the coronary arteries, and restore the blood to the myocardium. Commonly used thrombolytic drugs include streptokinase and urokinase, which can dissolve cellulose and cellulose in the blood through different ways, thereby dissolving the thrombus.

Thrombolytic therapy can be divided into two types: intracoronary thrombolysis and intravenous thrombolysis. Intracoronary thrombolysis is a catheter that is inserted through the artery into the coronary artery and then injected with urokinase or streptokinase to dissolve the thrombus in the coronary artery. The success rate is 68% -89%. However, intra-coronary thrombolysis requires arterial intubation, which may be delayed for a certain period of time, so intravenous thrombolysis has been adopted in recent years. Intravenous thrombolysis does not require intubation, and can be performed in general hospitals and even in ambulances, so it is more widely used. In a short period of time, generally 500,000 to 1.5 million units of streptokinase are dripped into a vein within 30 minutes, and the effective rate ranges from 50% to 90%.

In patients with successful thrombolytic therapy, the symptoms of chest pain are rapidly reduced or disappeared, the electrocardiogram is improved, the process of cardiac function recovery is accelerated, and the scope of myocardial infarction is significantly reduced. The key to the success of thrombolytic therapy is to start early, the sooner the better. It is generally believed that if the myocardial infarction has exceeded 6 hours, the effect is poor.

The main disadvantage of thrombolytic therapy is that inaccurate dosage can cause bleeding. In addition, there may be arrhythmias after coronary recanalization, but this arrhythmia occurs for a short time, as long as it is handled in time, it will not be life-threatening.

Indications and contraindications for thrombolytic therapy for acute myocardial infarction

Thrombolytic indications:

1. Persistent chest pain half an hour, symptoms of taking nitroglycerin do not ease.

2. The ST segment elevation of two or more adjacent leads is> 0.1m V in the limb lead and> 0.2m V in the chest lead.

3. Onset 6 hours.

4. If the patient comes to the hospital 6 to 12 hours after the onset, the ST segment elevation of the ECG is significantly associated with or without severe chest pain, and thrombolysis is still possible.

5. Age 70 years. Patients with AMI over 70 years of age should be based on the scope of the infarction, the general state of the patient, and whether there are factors such as hypertension and diabetes.

Different people choose carefully.

Contraindications to thrombolysis

1. Active bleeding (gastrointestinal ulcer, hemoptysis, etc.) within two weeks, had visceral surgery, biopsy, and traumatic cardiopulmonary resuscitation,

Can not perform compression vascular puncture and history of trauma.

2. Patients with hypertension still have blood pressure 21.3 / 13. 3k Pa (160 / 100mm H g) before thrombolysis after treatment.

3. Highly suspected of dissecting aneurysms.

4. History of cerebral hemorrhage or subarachnoid hemorrhage, history of ischemic stroke (including TIA) within> 6 hours to half a year.

5. Have a history of hemorrhagic retinopathy.

6. Various blood diseases, hemorrhagic diseases, or people with bleeding tendency.

7. Patients with severe liver and kidney dysfunction or malignant tumors

Signs of thrombolytic recanalization in thrombolytic therapy for acute myocardial infarction

1. Judgment of vascular recanalization by coronary angiography

2. Indirect judgment: The ST segment of the ECG rises by> 50% within 2 hours. The chest pain disappears within 2 hours. Reperfusion arrhythmia occurs within 2 hours. The serum CK-MB enzyme peak is advanced (within 14 hours).