Lege Artis Medicinae

[PERCUTANEOUS CORONARY INTERVENTION IN ACUTE CORONARY SYNDROME]

ANDRÁSSY Péter

NOVEMBER 30, 2005

Lege Artis Medicinae - 2006;16(01 klsz)

[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.]

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[LOWERING BLOOD PRESSURE IN ACUTE CORONARY SYNDROME]

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[Early monitoring and management of patients with acute coronary syndrome takes place in coronary units. Hypertension is one of the main risk factors of the syndrome. Many patients have high blood pressure in the acute situation, and it may be further increased by the acute stress effect. To ensure controllability of blood pressure, intravenously administered nitroglycerine, beta receptor blockers, angiotensin-converting enzyme inhibitors, and centrally acting drugs are the medications of choice in the management of acute coronary syndrome.]

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[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.]

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[ANTITHROMBOTIC MEDICAL TREATMENT IN ACUTE CORONARY SYNDROME]

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[Treatment of acute coronary syndrome has extensively changed during the last two to three decades. Improvement of medical care resulted in a strikingly lower hospital mortality, at least for acute coronary syndrome with ST-segment elevation. Currently, invasive revascularisation procedures have stepped into the limelight of medical activities. The success of this instrumental intervention has been due the development of aggressive adjuvant antithrombotic therapy. In our country, management of patients with acute coronary syndrome has also changed fundamentally, restructuring care system. This has at the same time resulted in better adherence to professional guidelines.]

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[LIPID LOWERING IN ACUTE CORONARY SYNDROME]

MÁRK László

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

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[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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