Myocardial infarction: When to take fibrillators, when to intervene?

The article is consulted professionally by Master, Dr Pham Van Hung – Interventional Cardiologist – Medical Examination and Internal Medicine Department – Share99 Da Nang International Health Hub

Myocardial infarction is a dangerous pathology caused by a sudden blockage of blood vessels that feed the heart. When the heart muscle is completely not supplied with blood, the myocardial muscle will necrosis causing symptoms of severe chest pain.

Myocardial infarction is a sudden thrombosis that clog the coronary artery (blood vessel that feeds the heart). This phenomenon makes the blood do not flow to feed the heart muscle and kill part of the heart muscle. Blockage of large blood vessels can cause the heart to stop beating or it can cause deadly arrhythmias.

Many people only have very mild chest pains or feel discomfort under the sternum. These signs can be fleeting and then normal right away. Even people with myocardial infarction may not notice this symptom until other painful symptoms occur.

The most obvious warning symptom is chest pain: Chest pain is usually in the middle of the sternum and lasts for a few minutes. The pain can appear and then go away and hurt again. The pain makes the person feel like something is pressing on the chest, pain like a knife or feeling suffocated.

• Pain can also appear in other locations such as in the back, on the neck, on the jaw or the end of the body.
• Shortness of breath is often associated with chest pain.
• Some other symptoms may also be accompanied by: cold sweating, vomiting or mild headache.

• Men over 45 and women over 50 are at high risk for myocardial infarction. However, young people may also have myocardial infarction but have fewer rates.
• People who have had a heart attack before are very likely to have a heart attack again next time.
• People with a family history of early myocardial infarction such as a father or brother with a myocardial infarction under the age of 55 and a mother or sister with a myocardial infarction under the age of 65.
• Patients with diabetes mellitus have a similar risk of myocardial infarction to patients with a history of myocardial infarction.
• People with high risk factors such as: dyslexicdisorders, high bloodpressure , smoking, obesity, less physical activity are those who are prone to myocardial infarction.

The mortality rate from myocardial infarction in the world was previously about 30-40%, today it has been reduced to 20%, and in the last 4 decades it has decreased to about 6-10%: all thanks to the urgency of treatment.

Moreover, it is necessary to urgently treat it immediately because re-perfusing with coronary angioplasty will have much better results if done in the first 12 hours, or re-perfusing with fibroid pepper drugs will be very effective if the drug is taken as early as possible (in the first 2 hours) and must not be late after the 6th hour.

Recently, it has been suggested that it is allowed to use fibrillation drugs that dissolve thrombosis after 6-12 hours even up to 24 hours when except for conditions: necrosis is progressing (manifestations of continued chest pain), st segment (of electrocardiosis) continues to increase and heart enzymes continue to increase.

Once a diagnosis of myocardial infarction has been identified, the rule is: there is no need to wait for the results of the "heart marker (cardiac enzyme) test", but to quickly prescribe it as soon as possible to take intravenous fibrillation drugs. The effect of fibrosis drugs is to dissolve thrombolysis, so fibrosis is classified as "Coronary Re-perfusive" treatment.

4.1 Absolute contrainttraint

• History of incranial hemorrhage.
• Blood aneurysms, cerebral arteries-veins.
• History of in-skull tumors.
• Isiococemia stroke < 3 tháng.
• Transient brain issemia < 6 – 12 tháng.
• Aortic dissection.
• Serious injuries <3 tháng.
• Uns controlled severe hypertension (> 180/110mmHg).
• Disorders of blood clot factors.
• History of stroke due to brain haemorrhage.
• Acute pericarditis.
• Pregnant < 5 tháng.

4.2 Relative contrainttrainnities

• Gastric ulcer, enteritis.
• Visceral hemorrhage (2-4 weeks).
• Is is is an isiemia stroke has been > 3 months.
• Prolonged cardimonary resuscitation (>10mph) causes trauma.
• surgery < 10 ngày; phẫu thuật thần kinh < 2 tháng; đại phẫu < 3 tháng.
• History of in-eye bleeding (retinopathy of the eyes to give birth; eyeball surgery).
• Menstruation, heavy blood.
• Bleeding.
• Poking < 24 – 48 giờ. Other invasive tricks <10 ngày.
• Digestive/urinary – genital bleeding <10 ngày.
• Lung disease has a chronic burrow.

4.3 Possible accidents

• Incranial hemorrhage 0.7% – 0.9%.
• This risk doubles in adults >75 years old, who have severe hypertension.

4.4 Signs of fibrosis drugs that achieve treatment results

• No chest pain.
• The ST's over.
• Ventilated arrhythmias may appear (due to re-perfusculation).

4.5 If the result is not achieved (60 – 90 minutes after the oncological oncological ingestion) there will be the following manifestation

• Persistent chest pain.
• Reduce ST spreads to only < 50%.

Coronary artery intervention in case of acute myocardial infarction without the use of fibrillator :

• Myocardial infarction is more than 6 – 12 hours
• Contrained by the drug of blood scare.

In case of taking fibrosis drugs may not be able to overcome the risk of major life-threatening complications:

• Threatening or having a heart attack.
• Heart failure worsens.
• A new left branch appears.

After ineffective fibrosis drugs

• Taking fib fib fibly medications, if 60 -90 minutes do not work (persistent chest pain remains, reduce ST difference to only < 50%) thì cần khẩn cấp chỉ định can thiệp động mạch vành.

• Regarding the cure of myocardial muscles, coronary artery intervention does not lose to fibrillators. Generally patients feel coronary artery intervention improves fibrosis better.
• As a result, in terms of reducing myocardial infarction, reducing mortality, coronary artery intervention is better than a conventional fibrillator.
• Coronary artery intervention also avoids the threat of complications of intracranial bleeding (especially in patients aged 60-75 years)

When considering between medication and cardiovascular intervention, there are many aspects, but the basic thing is to choose how to re-irrigate the coronary artery in time.

• Take half a dose of fibrosis and transfer coronary artery intervention immediately.
• After consuming fibrosis (both doses) for 2-7 days, every patient is treated with additional coronary artery intervention, called delayed coronary artery intervention.
• After consuming fibrillosis (both doses) 2 days (48 hours), if the patient presents with myocardial ishoma, choose to intervene in the coronary artery supplement.

Nowadays, after the treatment of fibrosis drugs, coronary artery intervention is always accompanied by stents (support frames) to completely reduce coronary stenosis after 6 months combined with anti-thrombotic drugs.

It can be seen that the examination, screening and diagnosis of cardiovascular diseases are very important, including urgent cardiovascular emergency measures. Fibrillator treatments for patients with acute myocardial infarction at Share99 International Health Hub have a success rate of over 95%. Fibrillation drugs are used for patients with myocardial infarction prescribed under the guidance and close supervision of cardiologist, experienced and modern equipment.