Myocardial Infarction

Although a myocardial infarction (MI), or heart attack, is most commonly a result of arteriosclerosis, there are various methods of analyzing the warning signs of a potential heart attack. Cath Lab Digest provides greater insight into the catheterization procedures involved in the prevention and treatment of heart attacks. Feel free to browse through our articles below.

Primary Angioplasty at Community Hospitals in the 21st Century Now The Treatment of Choice for Myocardial Infarction at Qualified Hospitals Without Cardiac Surgery It was 2 am the night after Thanksgiving. John went into the bathroom to try to relieve his chest pain. He vomited copious amounts of bloody coffee-ground material and passed out. His wife awakened hearing his fall. She found John on the floor and called 911 immediately. John was brought to the local emergency department (ED) in the nearby community hospital, obtunded, white, cold and clammy with a systolic pressure of 80 mmHg and with ?tombstone? ST elevation indicating a large infero-apical-lateral myocardial infarction (MI) on EKG. His pajama shirt was covered with bloody vomitus.

Successful Implementation of a Cardiac Interventional Program Without On-site Surgical Backup at Howard Regional Health System We chose to do elective as well as urgent/acute PCIs. We wanted to not only provide interventional cardiology services, but to perform them well, utilizing the ? One patient (0.3%) had a failed PCI that required transfer for emergent CABG.

Commentary Response: Primary Angioplasty is Now the Benchmark for the Treatment of AMI and Needs Broader Access We are flattered by the attention that Dr. Thomas J. Ryan has given to our admittedly provocative article ? attention which highlights the importance of the surgical back-up question and the strong feelings that have been aroused on both sides. We appreciate Cath Lab Digest?s invitation to respond to his commentary. Our response will address the following issues:

Improved Efficiency in Acute Myocardial Infarction Care Through Commitment to Emergency Department Initiated Primary PCI ABSTRACT: Study objective. Methods. Establishing the clinical and business case for process change.

Biology of the Vulnerable Plaque: Part I Over 1.2 million cardiac catheterizations are performed in the United States each year, at a great cost to health care resources. The spectrum of clinical indications which lead to these procedures can for the most part be broadly divided into two categories: stable angina and the acute coronary syndromes, the latter manifested by unstable angina, acute myocardial infarction, and sudden death.

How Drug-Eluting Stents Will Impact the Treatment of Acute Coronary Syndromes, Use of GP IIb/IIIa Inhibitors, and U.S. Hospitals The basic pathophysiologic mechanism of acute coronary syndromes (ACS) involves a generalized, multicentric inflammatory arteritis. Stenting an isolated ?culprit? lesion does not ?treat? the non-culprit lesions which are usually present in these patients. Furthermore, drug-eluting stents (DES) are still associated with an appreciable incidence of periprocedural myocardial infarction (6.5% in the Sirolimus [SIRIUS] trial preliminary analysis) which is similar to that observed for non-DES. DES, as a focal or localized treatment for a more generalized underlying disease process, will likely require adjunctive pharmacotherapy to achieve optimal clinical outcomes. As we are currently on the eve of DES availability in the United States, a review of current understanding of the pathophysiologic processes involved in ACS and the proposed role of DES in its treatment is warranted.

Tips to Improve Door-to-Balloon Time to < 90 Minutes: Life in the real world Introduction The American Heart Association (AHA) in 20051 stated cardiovascular disease (CVD) is the ?single largest killer? of individuals in the United States. Thirteen million Americans suffer from coronary artery disease (CAD). Nineteen percent of our workforce is presently permanently disabled by this disease. Approximately 865,000 people suffer from a ST-elevation (STEMI) and non-ST-elevation (NSTEMI) myocardial infarction (MI) annually.

Clinical Update: Primary Angioplasty Without On-site Surgical Back-up: The First Experience with Mobile Catherization Facility Background and objectives. The aim of the present study is to assess the safety and efficacy of performing primary angioplasty in a center without on-site surgical back-up, and compare the data with the literature. Methods. Seventy-eight consecutive primary angioplasty procedures, performed in our center from January 2001 to February 2003, were followed prospectively. Clinical and demographic characteristics of the patients, procedural success, early and late outcomes of the patients were taken into account. The safety of angioplasty was assessed by the analysis of in-hospital complications (death, urgent need for repeat revascularization, AMI with or without ST-elevation and stroke). The angioplasty procedures were considered effective when the post-procedural residual stenosis did not exceed 50% with the distal Thrombolysis in Myocardial Infarction (TIMI) grade III flow. Results. The device success rate was 92.3%. Angiographic success rate was 88.8%. In hospital mortality rate was 4.1 %. These patients were admitted with cardiogenic shock; 1 died during the procedure and the other 2 died during hospital follow-up. One patient died suddenly and another developed acute MI during the 6-month follow-up period. No patients developed stroke or were referred for urgent surgery. Four patients (5.5%) underwent repeat angioplasty during follow-up. Conclusions. Primary angioplasty can be safely performed in centers without on-site surgery. The efficacy and safety requirements of angioplasty, performed in a center without on-site surgical back-up using a mobile catheterization facility were similar to the data obtained from the literature.

The Use of an XMI-Rapid Exchange Rheolytic Thrombectomy Catheter During an Acute Myocardial Infarction Secondary to Thrombus Burden of the Right Coronary Artery: A Case Study Acute myocardial infarctions caused by ruptured plaque can create a large thrombus burden down the infarct-related artery. This acute thrombus can be treated in several ways. The current treatment for ST-segment elevation myocardial infarction is immediate revascularization through percutaneous coronary intervention (PCI).1 During PCI balloon dilation, the dissolution of this acute thrombus can result in embolization to the distal micro-vasculature, causing myocardial injury. This injury may be reflected in a further increase in myocardial enzyme levels and eliciting further myocardial damage.2

Primary Angioplasty at Community Hospitals in the 21st Century: A Commentary Performing coronary angioplasty in the catheterization laboratories of community hospitals that do not have their own accredited cardiac surgical programs is something not done as a rule in the United States. As a matter of policy, is this wrong? Does it fly in the face of compelling data to do otherwise? Is it yet another example of providers and regulators constraining qualified physicians from doing what is necessary to properly care for a patient? The adjacent article by Wharton and colleagues would seem to suggest that is the case. Others would disagree and attribute such a point of view to unbridled enthusiasm for primary angioplasty, a reperfusion strategy for the management of select patients with acute myocardial infarction that is increasingly used as an alternative to thrombolytic therapy.