"mikyro" wrote:in case of st elevation MI what is first choice.. thrombolysis or ptca with stent. Dear Noelle - here's a nice algorithm presented to me by a doc from the dept. of cardiovascular medicine at NYH: MI confirmed: NEXT step in the management: Consider hemodynamic stability If hemodynamically stable - NEXT: Are thrombolythics counterindicated? YES - NEXT: Consider PTCA NO - NEXT: Consider thrombolythics (especially if within 3-4 hrs of onset) If hemodynamically unstable - resuscitate first - NEXT: apply the above algorithm. Simple and effective  . Hope it helped.
It is very good algorithm but I am still confused :oops: can any one help me :?:
Let me put my confusion in different case scenarios (keep in mind that no patient had any contraindication to Thrombolysis) :idea:
1. Patient with MI, Hemodynamically stable presented to you about 2 hours of pain.
2. Patient with MI, Hemodynamically stable presented to you about 2 hours of pain.
3. Patient with MI, Hemodynamically unstable presented to you about 5-6 hours of pain
4. Patient with MI, Hemodynamically unstable presented to you about 5-6 hours of pain
What will be your choice for each of these patients?
A. Thrombolysis B. PTCAS with stent
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| mdwannabe
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PTCA FIRST!!! themn thromblys.
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| SA
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"mdwannabe" wrote:
PTCA FIRST!!! themn thromblys.
For every patient :?: mdwannabe
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| mikyro
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It is very good algorithm but I am still confused can any one help me
Let me put my confusion in different case scenarios (keep in mind that no patient had any contraindication to Thrombolysis)
If indeed no CI to thrombolythics - then:
1. Patient with MI, Hemodynamically stable presented to you about 2 hours of pain.
Thromolythis
3. Patient with MI, Hemodynamically unstable presented to you about 5-6 hours of pain
Resuscitate first;
NEXT: PCTA (thrombolysis is an option, but not as affective as PCTA).
If the patient is hemodynamically unstable - it means that an important part of the heart muscle is damaged - for eg: sever LV infarction or LV & RV infarction; the goal is to establish coronary circulation in the damaged vessels as soon as possible to save as much residual heart muscle as possible; otherwise the resuscitative measures will eventually prove ineffective; besides, thrombolythics don't act as fast as PCTA; in either case however you should expect of a more frequent occurrence of reperfusion arrhythmias - I read in a medical book that the more amount of heart muscle is damaged, the more likely the reperfusion arrhythmias to occur.
Hope it helped .
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the same miky - always ready to help my patients and friends as well
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| SA
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Thanks I got it
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| mdwannabe
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as far as I know statiscally/ clinically pts with PTCA do better and have less complications then thrombolytics. So the algorythm is consider PTCA first, if not available or pt unstable to transfer to where it is ... consider thrombolytics.
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| lucky
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i read the same , that if possible do ptca first then thrombolytics if ptca not possible.
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| SA
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it means if both the option available then there is not role of thrombolytics in acute managment of MI not even in a stable patient within 1 to 2 hour of attack :?:
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| jalwa
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go or ptca with or with out stent if available in the set up
if not available go for lytic therapy
ptca more effective than lytic therapy
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