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Definition
It is divided in 2 stages: the treatments on the premises given by the Ambulance Service Staff, and the treatment in cardiology intensive care units. 1 - The treatment on the premises - Prescription of a medicine against the pain: Morphine by hypodermic or intra venous way (in a reasonable dose in order not to conceal a new occurrence of a thoracic pain), - Prescription of a medicine encouraging the dilation of the heart artery: nitroglycerine under the tongue sometimes followed by the prescription of this product by way i.v. - Aspirin is administered in the dose of 250 mg by i.v., with an antisludgeaim; - An anti-coagulant treatment is prescribed by i.v. or under-cutaneous way; - Medicaltransportation with monitoring of the cardiac activity, - In case of bradycardia (heart slowing), prescription of atropine by i.v., - If numerous or threatening ventricular premature beats exist, the physician prescribes Xylocaine® by i.v., - A left cardiac failure requires the injection of a diuretic drug encouraging the draining of the water present in the lungs; it also demands the prescription of medicines encouraging the contraction of the heart (drugs having the same action as adrenaline). - Sometimes, a medical treatment aiming at quickly unplugging the coronary artery is undertaken as quickly as possible, before arriving to a cardiology centre: administration of antisludge powerful platelet medicines by i.v. and possible achievement of a thrombolysis (see chapter about this subject). 2 - The treatment in cardiology intensive care units
The questioning upon arrival succinctly eliminates the possible contra-indications to the treatments. The exam searches for the immediately threatening complications and the treatment then rests on: - Absolute rest with sedatives if needed; control of the heart activity; oxygen therapy in case of oxygen reduction in blood or anaemia, - To encourage the dilation of the heart artery and avoid the occurrence of an acute lung oedema, nitroglycerine can be administered through an electric syringe if the BP permits it, - A beta-blockers treatment is sometimes prescribed, if the heart is not too slow and too “tired”, - Studies have shown that the emergency administration of a hypocholesterolaemic drug (lowering cholesterol) belonging to the of the “statins” family could be interesting; - I.v. or hypodermic heparin is also prescribed, to encourage the destruction of a blood clot blocked in the coronary artery and avoiding the passage of blood, - Aspirin is first of all prescribed by intra way venous then in tablets. It also aims at dissolving blood to avoid the formation of a clot. - The thrombolysis. A treatment aiming at dissolving the blood clot localized in the heart artery and responsible for the infarct can be instituted. It is a powerful treatment, including many side effects, and it must be administered precociously, at best within 2 hours, at worst within 6 hours. This treatment is called thrombolysis; it is less and less used because of the comfortable recourse to an instrumental revascularisation gesture of the cardiac muscle. Contra-indications must be scrupulously respected: antecedents of cerebrovascular accident, evolutionary gastro-duodenal ulcer, HBP >220/120 mmHg, treatment by vitamin K antagonist anticoagulant drug, recent surgery, pregnancy. Every treatment of fibrinolysis... is administered according to a precise protocol. The success of a thrombolysis is attested by: - A sedation of the pain during the treatment, - The improvement of the signs initially observed on the electrocardiogram, - A tachycardia (acceleration of the heart frequency), a benign characteristic of the heart muscle reperfusion, - A precocious spike of CPK enzymes, before the 12th hour. But sometimes, the above-described medical treatment is either not indicated, or it fails. An instrumental treatment of the clogged heart artery is then proposed: it is a coronary angioplasty. File last modified on july 24, 2006 |
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MEDICAL
TREATMENT
Informations
on Heart & Vessels are only given by doctors who are specialized
in cardiology.