Rapitful Shqip

What do you know about post-MI risk stratification ?  • Risk stratification before hospital discharge is an important aspect of manage-ment and determines whether coronary angiography is indicated. • The first step is to determine whether the clinical variables indicatine a relatively high risk for future cardiac events are present: 1. Patients who have recurrent ischaemia at rest or with mild activity, who have had evidence of congestive heart failure or who are known to have an ejection traction below 40% and in whom there are no contraindications for revas-cularization should undergo cardiac catheterization and coronary angiography. Revascularization should then be carried out if the coronary anatomy is suitable and there are no contraindications. 2. Patients who have had an episode of ventricular fibrillation or sustained ven-tricular tachycardia more than 48 hours after acute MI should be considered for electrophysiological study or amiodarone therapy, or both. 3. In patie

What is the role of glycoprotein lib/Ilia antagonists as adjuncts to thrombolytic therapy in acute MI ?  After thrombolytic therapy for acute MI, full anterograde perfusion (TIMI grade 3 flow) occurs in only 29-54% of patients at 90 minutes while reocclusion occurs in at least 12%, with increased morbidity and mortality. Thrombolytic therapy may itself be prothrombotic by releasing clot-bound thrombin, which in turn stimulates platelet activation. Preclinical and early clinical trials have suggested that glycoprotein llb/llla receptor blockers (which prevent fibrinogen binding to platelets) used as adjuncts to thrombolytic therapy may improve early patency and reduce the incidence of reocclusion. A large randomized trial has recently confirmed the early findings on patency and suggests that adjunctive treatment with glycoprotein Ilb/IIIa receptor blockers may hold promise for better management of acute MI. The results from the GUSTO-AMI phase III trial using abciximab with reduced

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What do you know about the open infarct-related coronary artery hypothesis ?  This hypothesis holds that early reperfusion of the infarct-related coronary artery results in myocardial salvage, which preserves left ventricular function and is responsible for improved survival. Patients with complete occlusion of the coronary artery (TIMI grade 0) 90 minutes following thrombolysis had a 30-day mortality of 8.4%, whereas mortality was 4% in patients with TIMI grade 3 flow (complete perfusion).

What do you know about right ventricular infarction ?  Right ventricular infarction presents with retrosternal chest discomfort, nausea, vomiting and diaphoresis, unlike left ventricular infarction which presents with dyspnoea. On examination in right ventricular infarction, there is a raised jugular venous pressure with no evidence of pulmonary congestion; the patient often has a Iow cardiac output with hypotension. The patient typically presents with ST elevation in the inferior leads (II, III and aVF) and in one or more right-sided leads, particularly V4R. The cornerstones of therapy include restoration of infarct artery patency, intravascular volume expansion and inotropic support.

What is the role of troponins in the diagnosis of myocardial infarction ?  Raised concentrations of the myocardial regulatory protein troponin I are highly specific for myocardial injury. Estimation of troponin I concentration may be par-ticularly useful in patients with acute or chronic skeletal muscle disease or those with renal failure in whom the CK-MB (MB isoenzyme of creatine kinase) level may be raised in the absence of myocardial infarction. The measurement of troponin 1 is a sensitive and specific method (more specific than CK-MB) in the setting of perioperative myocardial infarction. Troponin T is also useful because it has a large diagnostic window, as it is increased from 12 hours to 10 days after myocardial infarction.