Reperfusion Therapy
If the myocardial infarction is confirmed and the transport of the patient to the hospital takes a long time, a thrombolytic therapy can be initiated by the emergency physician (for thrombolytic therapy see below). It is also important to treat any complications that arise during transport to hospital and to take further measures at the clinic. Once the patient is in hospital, the hospital phase interventions begin.
The general measures already begun are continued under intensive medical circulation monitoring and in readiness for resuscitation (readiness for resuscitation). Rapid reperfusion therapy to reopen the vessels has top priority: thrombolyst therapy represents the conservative therapeutic procedure for heart attacks. Here, activators of fibrinolysis will be administered by infusion: The drugs dissolve blood clots (thrombolysis).
This is called systemic lysis because the necessary drugs are administered via the vein and reach the coronary arteries via the blood vessel system. The requirements for this therapy are: An accompanying heparin therapy, which also serves to dissolve the thrombus, improves the result of the lysis. In about 70-85% of the treated cases, a reopening of the vessel within 90 minutes after the infusion is observed.
Mortality within the first 35 days after acute infarction can be reduced by 50% by fibrinolysis. Physical (clinical) criteria for successful revascularization are the disappearance of chest pain and a normalization of the ST stretch in the ECG, which was previously increased by the infarction. These clinical signs are indirect criteria for monitoring the success of therapy.
Direct evidence of the success of therapy is provided by coronary angiography (visualization of the patency of the coronary vessels). In 20-25% of cases, the coronary vessel is closed again after lysis therapy. Therefore, all patients should be transferred to a cardiology center after completion of this therapy, where coronary angiography is performed to check the vascular status.
If necessary, the re-opening of the re-closed vessel can be connected immediately. Contraindications that speak against lysis therapy are If these diseases or conditions are present, fibrinolytic therapy must not be performed because a life-threatening bleeding complication must be expected.
- Streptokinase
- Alteplase (r-t-PA) or
- Reteplase (r-PA)
- A fresh heart attack that began no more than 6 hours ago
- Visible changes in the ECG and
- The absence of contraindications (contraindications) for the treatment.
- Stomach and intestinal ulcer (ulcera)
- Ocular fundus bleeding
- Acute headaches
- Blood coagulation disorders in the medical history
- A stroke less than 6 months ago (apoplex) and
- An operation or accident less than 1-2 weeks before.
