sheena2005
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when a patient presents within an hour of onset of MI. waht is the best initial therapy PTCA or thrombolysis.i am confused here because kaplan says PTCA is indicated only when thrombolysis is contraindicated, but UW says PTCA is preffered over thrombolysis.
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| sheeezooo
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untill now i saw a question in cardio uw..in which the pt has history of hemmorrhagic stroke 6 months befoe.. also has MI with st segmant elevation cuz of previos stroke ..thrombolytic therapy will be contraindicated there..so PTCA is indicated and it has a better outcome..then thrombolysis..
more than 50 question remainin..may be i,ll see that then i can explain..but in my opinion PTCA will be good when thrombolytic therapy is contraindicated.
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| sheena2005
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the question id for this one is 645.there are no contraindications to thrombolysis in this patient.still they preffered PTcA
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| MDcooper
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patient with ST segment elevation confirms MI.In this case the management should be with aspirin,nitrates,beta blockers and thrombolytics.If the pt has bleeding like subarachnoid hemmorhage,malena etc..when thrombolysis is contraindicated,then u do angioplasty.
THIS IS WHAT THE DVDS SAY.
kaplan notes say that if both thrombolytics and angiiplasty are available at the same time,then angioplasty is prefered as it lowers mortality.if angioplasty is not available before or at the same time as angioplasty,then go for thrombolytics as we cannot delay and wait for 2 or 3 hours to get angioplasty facilities available.
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| docnikki
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Yes kaplaan says that PTCA is preferred and if its not available instead of waiting we should give thrombolytics.
but ahead it aalso says under the heading of angioplasty that they are given when thrombolytics are contraindicated...
so its confusing.
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| MDcooper
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again I think it depends on the question stem.If they are asking for the next best step,thrombolytics in the absence of contraindications will be the answer.If they say what is the best step in the management,then angioplasty should be the answer.
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| sheena2005
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docnikki u r right there two different things written in kaplan notes that's why i am confused too.from what i know clinically is that thrombolytics are used first if there r no contraindications.but then UW is also saying that if u angioplasty is the right thing to do even if there are no contraindications to thrombolysis.
Md cooper---the question is asking the next best step in managment.i think it should be thrombolysis, but explanation says that it should be angioplasty..................................................
u r right that angioplasty is the best step in managment.
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| MDcooper
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it makes me scratch my scalp .If UW and kaplan both say angioplasty is prefered,then I think they must be right.but still the initial best step seems to be thrombolytics.when a patient comes to ER with MI,no body immediately rushes him fo angioplasty,rather first they try the non invasive procedure to save the life and then go for angioplasty...I am not sure if we should be answering what is the ideal or what is actually done???but on boards,I thi nk we should go for angioplasty as books and UW says that.plz keep discussing and if some one can find any good article on this,it will help.
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| sheena2005
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too confusing
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| sheena2005
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one more confusion......
thrombolyse the patient within 12 hours of onset of pain. (kaplan)
thrombolysis should be given within 30 minutes of presentation.(UW)
that's a big time difference.
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| study_ing
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no confusion please...
u can either give throbolytics or PCI..its a matter of time and faciltiy..
obviously if there are contraindiactions, THrombolytics is the wrong answer.
the q u referred to , i think, had the patient come in in a major tertiary care hospital. right in the beginning...y?
recently, the trend is more towards PCI rather than thrombolytics. if u hav the facilities available and it can be done quickly, choose PCI.
even if u dont and tranfer to a centre wher pci can be done early, choose PCI..
now here's the trick..
what is early....dont remember, need to go thru the guidelines
so in general
1. is there a contraindication to thrombolytics..yes--> its not the answer.
2. is there the facility--if not, can u transport the pt nearby within th etime limit
3. ( time limit, i dont remember, but just to mention the approach )
4. in general if early, PCI is preferred.
the timeline's probably 1 hour ppl
Edited by study_ing on 09/13/06 - 04:28 PM
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| study_ing
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u can give thrombolysis within 12 hrs..however the mortality benefit is greates within the first half hour..
( remember for stroke, its 3 hours)
p.s this info i hav is a bit old..around 2004...will update later..plz concentrate on the approach to the q...we'll fil in hte times later
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| sheena2005
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ok i went thru the explanation again.patient is in the tertiary care facility.that means that if u have facility availble then u should go fot PTCA first.and the time limit for the course of actiion is 1 hour.
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| sheena2005
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thanks studying for clearing out the confusion.
yup mortality is better during first half hour.
all the best to everyone. i hope the confusion is solved for everyone.
APPLAUSE!!!!!!!!!!! for studying
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| sheeezooo
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..good work buddies..sheena bring the point..and i was aspectin studyin.. ..
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| study_ing
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thanx sheena for the time line ..will go edit my post to avoid confusion....
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| cbenitesch
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nice explanation study_ing!
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| study_ing
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| tolito
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