Heart Attack

Thrombolysis in myocardial infarction: indications for, contraindications, how they spend

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Thrombolysis in Myocardial Infarction helps restore blood flow to the heart muscle caused by a blockage of the coronary arteries. Used during the procedure drugs dissolve blood clots. therapy efficiency reaches 95% at the beginning of its timely. Despite the many positive qualities, such treatment has contraindications to identify who carried out the survey. Therapy is conducted in the department of cardiology.

Thrombolysis for heart disease

Indications for

Indications to thrombolysis in myocardial infarction are:

  • acute necrosis of heart period (6 hours after the first occurrence of attack);
  • small focal lesions of the heart muscle, accompanied by severe pain and the appearance of Q-wave on the ECG (in this case, thrombolytics administered within 12 hours after the onset of the acute phase infarction);
  • severely impaired heart rate;
  • acute circulatory disorders of the heart muscle.

Contraindications

Absolute contraindications to the administration of thrombolytics include pathological conditions characterized by an increased risk of blood loss:

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  • active bleeding (r. h. gastrointestinal endured in recent times);
  • aggravation of gastric ulcer and duodenal ulcer;
  • acute nonspecific colitis;
  • sharp, acute and subacute stage hemorrhagic stroke;
  • major surgery;
  • early post-natal period;
  • previously transferred subarachnoid hemorrhage;
  • severe head injuries.
Acute nonspecific colitis

Relative contraindications are:

  • estimated coronary artery dissection;
  • brain disease, not included in the list of absolute contraindications (transferred in the last 2 months, circulatory disorders of the brain tissue);
  • fresh head trauma, thoracic, abdominal and pelvic areas;
  • internal bleeding in history;
  • multifocal myocardial infarction accompanied by pronounced cardiosclerosis;
  • Chronic ulcer disease in remission;
  • hemorrhagic syndrome;
  • severe liver disease (cirrhosis, cancer, hepatitis);
  • glomerulonephritis;
  • clotting disorders (hemophilia and other diseases of the hematopoietic system);
  • hard, responds poorly to treatment of hypertension;
  • diabetic vascular lesions;
  • suspected pregnancy;
  • oral anticoagulants for a long time;
  • puncture transferred in a recent time receptacles;
  • carried out over the last 2 months of laser vision correction;
  • prolonged respiratory arrest;
  • allergic reactions to a history thrombolytics;
  • extensive burns.
thrombolysis

How to spend

Thrombolysis in myocardial carried out as follows:

  1. One hour before the patient is placed in a resuscitation procedure. It hosts an emergency survey aimed at assessing vital signs.
  2. Choice of thrombolytic. Use of preparations 1 generation (fibrinolysin, and streptokinase) is justified only in the absence of more efficient means. They slowly dissolve blood clots, over time the effectiveness of thrombolytic therapy decreases. Urokinase Alteplase and differ by more rapid action. They do not cause allergic reactions, and may be administered even after 6 hours after symptom onset.
  3. The introduction of thrombolytics. The drug is injected into an artery jet. Starting dose depends on the severity of vascular occlusion and status of the patient. The first step thrombolysis lasts 3 hours, after which proceeds to drip medication. The total dose of alteplase should not exceed 100 mg.

Within days after the procedure is prohibited to carry out catheterization of large vessels and put an intramuscular injection. Efficacy of treatment was determined by X-ray examination of coronary vessels. The procedure helps to assess the rate of dissolution of a blood clot, patency of the large arteries and blood character.

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  • transmural myocardial
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  • Atypical forms (variants) myocardial infarction
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