Infarto agudo al miocardio

Octubre 22, 2017. No. 2889

Metas incumplidas en el tratamiento del infarto agudo de miocardio: revisión. Unmet goals in the treatment of Acute Myocardial Infarction: Review. Farah A1, Barbagelata A2,3. Author information F1000Res. 2017 Jul 27;6. pii: F1000 Faculty Rev-1243. doi: 10.12688/f1000research.10553.1. eCollection 2017. Abstract Reperfusion therapy decreases myocardium damage during an acute coronary event and consequently mortality. However, there are unmet needs in the treatment of acute myocardial infarction, consequently mortality and heart failure continue to occur in about 10% and 20% of cases, respectively. Different strategies could improve reperfusion. These strategies, like generation of warning sign recognition and being initially assisted and transferred by an emergency service, could reduce the time to reperfusion. If the first electrocardiogram is performed en route, it can be transmitted and interpreted in a timely manner by a specialist at the receiving center, bypassing community hospitals without percutaneous coronary intervention capabilities. To administer thrombolytic therapy during transport to the catheterization laboratory could reduce time to reperfusion in cases with expected prolonged transport time to a percutaneous coronary intervention center or to a center without primary percutaneous coronary intervention capabilities with additional expected delay, known as pharmaco-invasive strategy. Myocardial reperfusion is known to produce damage and cell death, which defines the reperfusion injury. Lack of resolution of ST segment is used as a marker of reperfusion failure. In patients without ST segment resolution, mortality triples. It is important to note that, until recently, reperfusion injury and no-reflow were interpreted as a single entity and we should differentiate them as different entities; whereas no-reflow is the failure to obtain tissue flow, reperfusion injury is actually the damage produced by achieving flow. Therefore, treatment of no-reflow is obtained by tissue flow, whereas in reperfusion injury the treatment objective is protection of susceptible myocardium from reperfusion injury. Numerous trials for the treatment of reperfusion injury have been unsuccessful. Newer hypotheses such as " controlled reperfusion", in which the interventional cardiologist assumes not only the treatment of the culprit vessel but also the way to reperfuse the myocardium at risk, could reduce reperfusion injury. KEYWORDS: Controlled reperfusion; Myocardial Infarction; Reperfusion; Reperfusion Injury PDF Infarto del miocardio en UCIs. Revisión sistemática del diagnóstico y tratamiento Myocardial infarction in intensive care units: A systematic review of diagnosis and treatment. Carroll I1, Mount T2, Atkinson D2. Author information J Intensive Care Soc. 2016 Nov;17(4):314-325. doi: 10.1177/1751143716656642. Epub 2016 Jul 1. Abstract INTRODUCTION: Patients in the intensive care unit are vulnerable to myocardial injury from a variety of causes, both ischaemic and non-ischaemic. It is challenging for ICU clinicians to apply the conventional guidance concerning diagnosis and treatment. We conducted this review to examine the evidence concerning diagnosis and treatment of myocardial infarction in the ICU. METHODS: A systematic review was performed to identify relevant studies. RESULTS: 19 studies concerning use of ECG, cardiac enzymes, echocardiography and angiography were identified. 4 studies considered treatment of myocardial infarction. CONCLUSIONS: Regular 12 lead ECG or 12 lead ECG monitoring is more sensitive than 2 lead monitoring, regular measurement of cardiac enzymes is more sensitive than when provoked by symptoms. Coronary angiography rarely identifies treatable lesions, without regional wall motion abnormality on echocardiography. Evidence relating to treatment was limited. A potential strategy to diagnose myocardial infarctions in the ICU is proposed. KEYWORDS: Myocardial infarcation; critical care; PDFelectrocardiography; myocardial ischemia; troponin El valor pronóstico del índice de shock para los resultados de pacientes con infarto agudo de miocardio: una revisión sistemática y un meta-análisis. The prognostic value of shock index for the outcomes of acute myocardial infarction patients: A systematic review and meta-analysis. Zhang X1, Wang Z, Wang Z, Fang M, Shu Z. Author information Medicine (Baltimore). 2017 Sep;96(38):e8014. doi: 10.1097/MD.0000000000008014. Abstract BACKGROUND: Several studies have revealed that high shock index (SI) is a risk factor for acute myocardial infarction (AMI) patients. These studies do not give a systematic review in this issue. Therefore, we conducted a systematic review and meta-analysis to determine the effect of high SI on the prognosis of AMI patients.  CONCLUSION: High SI may increase the in-hospital mortality, short-term, and long-term adverse outcomes in AMI patients. PDF XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Informataion LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information

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