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Common Congenital Heart Lesions - page 48 / 126

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48 / 126

48 of 126

Acute Treatment of STEMI

  • Aimed at saving myocardium at risk necrosis via restoring blood flow through occluded coronary artery

  • Therapy decisions must be made early to save the most amount of myocardium, often before the appearance of biomarkers of necrosis Thrombolytics

  • Accelerates the lysis of the intracoronary thrombus to restore blood flow & limit subsequent myocardial injury

  • These are NOT used to treat UA or NSTEMI as they can cause more harm than good

  • Rapid initiation is crucial & has a profound effect on mortality rates

  • Includes Steptokinase, tPA, rPA, TNK-tPA, etc.

ThrombolyticsÆactivation of plasminogen into plasminÆfibrin clot lysis

  • Side effects: Bleeding due to poor substrate specificity (esp. seen with the older Steptokinase), as a result of fibrinogen lysis

  • Successful reperfusion: relief of chest pain; normal ST-T waves; earlier than usual peaking of serum biomarkers

  • Transient reperfusion arrhythmias may be present, but usually don’t require treatment

Primary Percutaneous Coronary Intervention

  • Performed in conjunction with cardiac catherization

  • Option for patients with contraindications for thrombolytics

  • Has higher rates of coronary reperfusion & survival without bleeding

complications

  • Drawbacks: expensive & limited to hospitals with prior experience

Antithrombotic & Antischemic Therapies

  • These agents are used to:

    • Maintain patency of the coronary vessel following thrombolysis

    • Restore the balance b/t myocardial O2 supply & demand

    • Relieve chest pain

    • Prevent complications of MI

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