European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
The earliest possible initiation of reperfusion therapy is necessary to prevent extended necrosis, preserve ventricular function, and reduce morbidity and mortality from acute myocardial infarction. Therefore, improving the time to thrombolysis is a critical goal of patient management. Four complementary strategies have been employed in an attempt to shorten the time to thrombolytic therapy: (1) public education to shorten the delay in summoning help, (2) prehospital thrombolysis by trained emergency-response personnel, (3) implementation of emergency department thrombolysis protocols, (4) and the use of rapid diagnostic techniques to confirm acute myocardial infarction. ⋯ Therefore, new thrombolytic agents have been bioengineered with characteristics that make them better suited for use in this setting. Two of these agents, TNK-t-PA and nPA, have extended half-life profiles that permit single-bolus dosing--an important consideration when fibrinolytic therapy is initiated outside the coronary care unit. The most effective system will integrate these complementary strategies to deliver continuous patient care from the time of the call for help, through emergency response, transportation, hospital admission, assessment, and initiation of thrombolytic therapy.
-
Atrial fibrillation (AF) is the most common cardiac arrhythmia observed in the emergency room (ER). We propose a new classification of AF which is useful for the standardization of terms to be used for future clinical trials and for clinical management of this arrhythmia in the ER. We recognized three categories: (1) atrial fibrillation lasting less than 72 hours (AF < 72 h); (2) persistent atrial fibrillation and (3) permanent atrial fibrillation. ⋯ In persistent AF the systemic thrombo-embolism is a significant risk and therapeutic anticoagulation must be associated to pharmacological or electrical cardioversion even though transoesophageal echocardiography does not visualize thrombi or spontaneous echocontrast in the cardiac chambers. These treatments can reconvert the persistent AF to sinus rhythm, but, in the absence of treatment, or if treatment fails, the arrhythmia goes into the permanent category. In permanent AF ventricular rate control and anticoagulation, if suitable, are the first choice for stroke prevention.
-
Review Case Reports
Acute myocardial infarction induced by alcohol ingestion in an asymptomatic individual.
This case report deals with a 47-year-old asymptomatic man without risk factors for coronary artery disease. He developed acute myocardial infarction 6 hours after ingestion of 0.5 litre of whisky within 30-60 minutes. ⋯ The sequence of events and objective data support our hypothesis that disturbance of coronary flow could be induced by an excessive ingestion of alcohol. The article discusses possible mechanisms of alcohol effects on arteries.
-
Review Comparative Study
Is there a gender difference in aetiology of chest pain and symptoms associated with acute myocardial infarction?
Many previous studies have shown that there is a gender difference in terms of the use of diagnostic procedures and the treatment of patients with chest pain. The mechanisms behind these observations are less well described. This survey describes gender differences in the aetiology of chest pain and symptoms associated with acute myocardial infarction (AMI). ⋯ In terms of electrocardiographic changes, women seem to have less marked ST deviations than men. However, we do not believe that these differences between women and men are substantial enough and, as a result, we do not recommend that the initial medical care of patients seeking medical attention with chest pain or other symptoms raising a suspicion of AMI should be differentiated with regard to gender. The differences described here might partly explain the prolonged delay until hospital admission in women suffering from AMI.