Lege Artis Medicinae

[LIPID LOWERING IN ACUTE CORONARY SYNDROME]

MÁRK László

NOVEMBER 30, 2005

Lege Artis Medicinae - 2006;16(01 klsz)

[A large number of studies have proved that in acute coronary syndrome the administration of statins improves clinical outcome by their lipid lowering effect, and also by stabilizing the plaque as part of their pleiotropic effects. An important question regarding statin therapy is when it should be introduced after the onset of symptoms. Studies on this issue agree that statin therapy should be initiated right after the onset of acute symptoms. If the patient is already receiving statin, we must make sure it is not abandoned. According to current Hungarian guidelines, for patients with acute coronary syndrome the target level of the low density lipoprotein cholesterol is 1.8 mmol/l.]

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Lege Artis Medicinae

[REHABILITATION AFTER ACUTE CORONARY SYNDROME]

SÁNDORI Klára

[Changes that have occurred in the treatment of acute coronary syndrome have also had an impact on rehabilitation. Unfortunately, current international and national professional guidelines barely take this into account. At present, most patients after acute coronary intervention are certainly not directed to take part in rehabilitation programmes. Thus those very patients miss these programmes who would gain the most benefit from a multi-disciplinary approach to rehabilitation. It would be necessary to develop standard guidelines for the selection of patients. The outcome of the interventions is highly affected by the patients' personality and psychosocial status. It has become obvious that in addition to physical exercise, which is useful but not a cure-all, psychosocial intervention is a key component of successful rehabilitation. This, however, is possible only by increasing the number of rehabilitation professionals and also by the fundamental improvement of financing.]

Lege Artis Medicinae

[ARRHYTHMIAS IN ACUTE MYOCARDIAL INFARCTION]

TOMCSÁNYI János

[Arrhythmias ranging from a premature beat to sustained tachycardias are common in acute myocardial infarction. This paper discusses the diagnosis, prognosis and treatment of the most frequent and important arrhythmias that may accompany myocardial infarction.]

Lege Artis Medicinae

[PERCUTANEOUS CORONARY INTERVENTION IN ACUTE CORONARY SYNDROME]

ANDRÁSSY Péter

[Recently the indications of percutaneous coronary intervention have changed both in the ST elevation and in the non-ST elevation, unstable angina group of acute coronary syndrome. Current indications in these groups are briefly reviewed and the outcomes and indications of primary interventions or those following successful or unsuccessful thrombolysis are discussed based on the most recent guidelines. Of the technical aspects, experience of the person performing the intervention, the issue of stent implantation or balloon expansion, and protection against embolism are mentioned.]

Lege Artis Medicinae

[AMBULANCE CARE OF ACUTE CORONARY SYNDROME]

BURÁNY Béla

[In Hungary, the advanced life support and mobile intensive care units of the National Ambulance Service are responsible for the effective praehospital care of patients with acute coronary syndrome. At the onset of chest pain, patients are supposed to call the ambulance service without delay. The dispatcher is to direct the most adequate unit to each patient. On-site treatment and optimization of medical care pathways are supported by existing algorithms. For early onset ST-elevation myocardial infarcts, praehospital fibrinolysis can provide the most benefit. Emergency secondary transports may lead to significant delays; therefore, this pathway should be limited to carefully selected cases.]

Lege Artis Medicinae

[THE MANAGEMENT OF ACUTE CORONARY SYNDROME IN CORONARY CARE UNITS WITH NO FACILITY FOR PERCUTANEOUS INTERVENTION]

RÓNASZÉKI Aladár

[The role of coronary care units with no facility for percutaneous intervention in the treatment of acute coronary syndrome has been greatly changed since pharmacological reperfusion approaches have been replaced by mechanical techniques, also with a wider indication. The planning of the traditional emergency treatment of patients admitted to such intensive care units depends on the necessity and possibility of primary percutaneous coronary intervention. Considering today’s professional requirements, all coronary care units, places of high patient turnover and employing highly qualified personnel, should be supplemented with facility for percutaneous coronary intervention.]

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