Thrombolysis in the management of heart attacks

Anyone who have been following my account lately would have been bombarded about heart attacks, angiograms, angioplasties, including images of a catheterisation lab. Today i will be talking about THROMBOLYSIS and its' usage in managing a heart attack. I am a cardiac nurse and presently working in one of the Heart Attack Centers in London where treatment and managements may differ to other parts of the world.

What is a thrombolysis?

It is the use of clot-buster medications to thin the blood to allow sufficient blood flow along a blockage or blockages in the culprit heart artery that caused the heart attack.

In my cardiac experience from 2001 in a general hospital, patients with ongoing heart attack were treated with thrombolysis in the Coronary Care Unit (CCU). Further management was then to treat the patient with whatever symptoms they may be suffering from secondary to their heart attack, starts with the standard cardiac medications, followed by stabilisation. A few days wait and an angiogram was done in our hospital who do this service. Angiogram findings that need angioplasty or surgery will warrant transfer to a Heart Attack Center for further interventions.

Our case study for today: a 64 year old diabetic male, thrombolised with streptokinase

Cropped medical report, courtesy of @zeddjacob

Admitted in a general hospital, the management is the same, thrombolysed with Streptokinase, with some of the same medications, 4 days hospitalisation and awaiting angiogram with possible angioplasty.

Streptokinase can only be given once in one's lifetime, and the reason that it is not favoured in its' usage is that there is an increased incidence of bleeding compared to Tenecteplace. 

I personally have not given any Streptokinase, only Tenecteplace. Although both are still stocked in our hospital, Tenecteplace nowadays is the drug of choice. 

For years now, the first line of treatment for heart attack is now Angioplasty, with thrombolysis as the choice in pre-hospital setting if access to a Heart Centre is not possible. Exemptions would be, if there is a delay in having the procedure due to the fact that during an out of hours heart attack service, there is only 1 team doing the procedure with a queue of patients with ongoing heart attacks at the same time. Another would be if a patient refused the procedure and would ask for another option in treatment, which is rare. Or a patient cannot tolerate the procedure and refused admission to the intensive care unit. 

In my experience before, thrombolysis have been effective to most patients, though some still have ongoing chest pain warranting immediate angiogram +/- angioplasty. 

A lot of research have shown that with thrombolysis, the mortality rate for patients increased due to bleeding. This then warranted more research to find another approach in managing heart attacks that lessens the mortality rate. Other lesser anti-coagulants were also introduced to stop the use of thrombolysis. Before 2004, The Heart Attack Centre (HAC) Pathway was not being implemented 24 hours a day , this too was funded by the government to run for 24 hours, 7 days a week.

Raising funds

Due to @zeddjacob's family member suffering from a heart attack last week, this post is to raise some funds to help with the planned angiogram+/- angioplasty in the Philippines, @steemph will donate all liquid funds raised to Zed.

"THANK YOU FOR YOUR SUPPORT"

Please leave a comment if you have anything to add, correct, suggest or request anything in cardiac that I can help you with. Tomorrow's post will be of different managements according to angiogram results.

https://steemit.com/bayanihan/@zeddjacob/fundraising-for-my-uncle-s-surgery