ST elevation myocardial infarction assessing success of reperfusion: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 37: Line 37:
==Guidelines (Do Not Edit)==
==Guidelines (Do Not Edit)==


{{cquote| 
===Class IIa===
===Class IIa===


It is reasonable to monitor the pattern of ST elevation, cardiac rhythm, and clinical symptoms over the 60 to 180 minutes after initiation of fibrinolytic therapy. Noninvasive findings suggestive of reperfusion include relief of symptoms, maintenance or restoration of hemodynamic and or electrical stability, and a reduction of at least 50% of the initial ST-segment elevation injury pattern on a follow-up ECG 60 to 90 minutes after initiation of therapy. (Level of Evidence: B) <ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>
It is reasonable to monitor the pattern of ST elevation, cardiac rhythm, and clinical symptoms over the 60 to 180 minutes after initiation of fibrinolytic therapy. Noninvasive findings suggestive of reperfusion include relief of symptoms, maintenance or restoration of hemodynamic and or electrical stability, and a reduction of at least 50% of the initial ST-segment elevation injury pattern on a follow-up ECG 60 to 90 minutes after initiation of therapy. (Level of Evidence: B) <ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>}}





Revision as of 20:23, 4 May 2009

Myocardial infarction
Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA, right coronary artery = RCA).
ICD-10 I21-I22
ICD-9 410
DiseasesDB 8664
MedlinePlus 000195
eMedicine med/1567  emerg/327 ped/2520

WikiDoc Resources for ST elevation myocardial infarction assessing success of reperfusion

Articles

Most recent articles on ST elevation myocardial infarction assessing success of reperfusion

Most cited articles on ST elevation myocardial infarction assessing success of reperfusion

Review articles on ST elevation myocardial infarction assessing success of reperfusion

Articles on ST elevation myocardial infarction assessing success of reperfusion in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on ST elevation myocardial infarction assessing success of reperfusion

Images of ST elevation myocardial infarction assessing success of reperfusion

Photos of ST elevation myocardial infarction assessing success of reperfusion

Podcasts & MP3s on ST elevation myocardial infarction assessing success of reperfusion

Videos on ST elevation myocardial infarction assessing success of reperfusion

Evidence Based Medicine

Cochrane Collaboration on ST elevation myocardial infarction assessing success of reperfusion

Bandolier on ST elevation myocardial infarction assessing success of reperfusion

TRIP on ST elevation myocardial infarction assessing success of reperfusion

Clinical Trials

Ongoing Trials on ST elevation myocardial infarction assessing success of reperfusion at Clinical Trials.gov

Trial results on ST elevation myocardial infarction assessing success of reperfusion

Clinical Trials on ST elevation myocardial infarction assessing success of reperfusion at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on ST elevation myocardial infarction assessing success of reperfusion

NICE Guidance on ST elevation myocardial infarction assessing success of reperfusion

NHS PRODIGY Guidance

FDA on ST elevation myocardial infarction assessing success of reperfusion

CDC on ST elevation myocardial infarction assessing success of reperfusion

Books

Books on ST elevation myocardial infarction assessing success of reperfusion

News

ST elevation myocardial infarction assessing success of reperfusion in the news

Be alerted to news on ST elevation myocardial infarction assessing success of reperfusion

News trends on ST elevation myocardial infarction assessing success of reperfusion

Commentary

Blogs on ST elevation myocardial infarction assessing success of reperfusion

Definitions

Definitions of ST elevation myocardial infarction assessing success of reperfusion

Patient Resources / Community

Patient resources on ST elevation myocardial infarction assessing success of reperfusion

Discussion groups on ST elevation myocardial infarction assessing success of reperfusion

Patient Handouts on ST elevation myocardial infarction assessing success of reperfusion

Directions to Hospitals Treating ST elevation myocardial infarction assessing success of reperfusion

Risk calculators and risk factors for ST elevation myocardial infarction assessing success of reperfusion

Healthcare Provider Resources

Symptoms of ST elevation myocardial infarction assessing success of reperfusion

Causes & Risk Factors for ST elevation myocardial infarction assessing success of reperfusion

Diagnostic studies for ST elevation myocardial infarction assessing success of reperfusion

Treatment of ST elevation myocardial infarction assessing success of reperfusion

Continuing Medical Education (CME)

CME Programs on ST elevation myocardial infarction assessing success of reperfusion

International

ST elevation myocardial infarction assessing success of reperfusion en Espanol

ST elevation myocardial infarction assessing success of reperfusion en Francais

Business

ST elevation myocardial infarction assessing success of reperfusion in the Marketplace

Patents on ST elevation myocardial infarction assessing success of reperfusion

Experimental / Informatics

List of terms related to ST elevation myocardial infarction assessing success of reperfusion

Cardiology Network

Discuss ST elevation myocardial infarction assessing success of reperfusion further in the WikiDoc Cardiology Network
Adult Congenital
Biomarkers
Cardiac Rehabilitation
Congestive Heart Failure
CT Angiography
Echocardiography
Electrophysiology
Cardiology General
Genetics
Health Economics
Hypertension
Interventional Cardiology
MRI
Nuclear Cardiology
Peripheral Arterial Disease
Prevention
Public Policy
Pulmonary Embolism
Stable Angina
Valvular Heart Disease
Vascular Medicine

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [3] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Assessment of Reperfusion

Myocardial contrast echocardiography (MCE), angiographic myocardial perfusion grade (MPG), and assessment of ST segment resolution are recognized as useful techniques for assessing myocardial perfusion.[1]

The relatively simple and readily available evaluation of the ST segment resolution that exceeds 50% at 60 to 90 minutes after reperfusion is a good indicator of enhanced myocardial perfusion.

Persistence of ischemic chest pain, absence of ST segment resolution and hemodynamic and/or electrical instability are generally indicators of failed pharmacological reperfusion and the need to consider rescue PCI and application of aggressive medical treatment.

Clinical Trial Data

According to TIMI-14 study which was evaluated 888 patients; patients with TIMI 3 perfusion and >70% ST segment resolution had substantial enhancement of survival compared with patients without ST segment resolution, and angiographically patent infarct related arteries.[2]

Guidelines (Do Not Edit)

Class IIa

It is reasonable to monitor the pattern of ST elevation, cardiac rhythm, and clinical symptoms over the 60 to 180 minutes after initiation of fibrinolytic therapy. Noninvasive findings suggestive of reperfusion include relief of symptoms, maintenance or restoration of hemodynamic and or electrical stability, and a reduction of at least 50% of the initial ST-segment elevation injury pattern on a follow-up ECG 60 to 90 minutes after initiation of therapy. (Level of Evidence: B) [3]


Sources

  • The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction [4]
  • The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction [3]

References

  1. Gibson CM (2003). "Has my patient achieved adequate myocardial reperfusion?". Circulation. 108 (5): 504–7. doi:10.1161/01.CIR.0000082932.69023.74. PMID 12900495. Unknown parameter |month= ignored (help)
  2. de Lemos JA, Antman EM, Gibson CM; et al. (2000). "Abciximab improves both epicardial flow and myocardial reperfusion in ST-elevation myocardial infarction. Observations from the TIMI 14 trial". Circulation. 101 (3): 239–43. PMID 10645918. Unknown parameter |month= ignored (help)
  3. 3.0 3.1 Antman EM, Hand M, Armstrong PW; et al. (2008). "2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee". Circulation. 117 (2): 296–329. doi:10.1161/CIRCULATIONAHA.107.188209. PMID 18071078. Unknown parameter |month= ignored (help)
  4. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)". Circulation. 110 (9): e82–292. PMID 15339869. Unknown parameter |month= ignored (help)

Template:SIB



Template:WikiDoc Sources Template:Mdr