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Expert Speak

Thrombolytic Therapy

Dr S Thanikachalam, M D DM , one of India’s leading cardiologists, and the Dean of Faculty and Head of Cardiac Care Centre Sri Ramachandra Medical College and Research Institute, Chennai,explains the function of the clot busting injection that can save the lives of heart attack patients.

What causes a heart attack?

In many people, the lumen ( the passageway) of the coronary arteries (arteries that supply blood to the heart) becomes narrow due to various reasons including high cholesterol, diabetes and smoking. In some patients luminal obstruction can be 40% -60% and yet does not interfere in regular activities or during exercise. Unfortunately for a few people the covering of the fatty plaque which is obstructing the vessel is not thick and is vulnerable to breakage.

A break exposes the toxic fat material within the block to the blood stream. Nature awakes at this point of time and thousands of platelets rush to this area. But in this process, uncontrolled migration of platelets totally plugs the vessel preventing the flow of blood through the vessel.
The heart muscle beyond this block is taken by surprise as the blood supply carrying nutrients and oxygen is cut off. The heart muscles, which have millions of cells needing oxygen and nutrients, start dying.
This is what happens internally during a heart attack
The patient experiences the constricting chest pain, so typical of a heart attack.

How does the life saving injection work?

The injection performs a clot dissolving function. It lyses or dissolves the freshly formed obstruction thus relieving the totally occluded lumen of the vessel. When the clot is dissolved, blood supply to the heart continues and stops further damage to the heart muscle.

How soon should the injection be given?

The patient should rush to the hospital as soon as he suffers acute chest pain. The first hour is critical. The best results from this treatment are to be had if the patient can be given the injection within 90 minutes of the onset of the chest pain.

Quite often, a patient may not be able to get to a hospital that soon…

Unfortunately so… This is why the concept of hospital on wheels is catching up in the advanced countries.

Are the medicines required for this injection available easily in India?

Yes, they are. The drugs that are commonly used are Streptokinase ( developed from the bacteria streptococcus) and Urokinase.

Is this treatment commonly followed in India?

It is the consensus treatment of choice and if a doctor does not administer this treatment to a patient who can be saved by this therapy, he can be accused of negligence.

Can this treatment be given to any patient who has a heart attack?

A very small percentage of people are allergic to clot busting drugs. A test dose has to be administered first and if they are allergic then the drug should not be given.
There are also others in whom this medicine cannot be administered, such as patients who have:

  1. A history of stroke
  2. Suffered a major injury recently
  3. Undergone a major surgery recently
  4. Uncontrolled high blood pressure
  5. Aged over 75
  6. Bleeding piles or liver disease
  7. Pregnant women.

What happens when people cannot get relief from this therapy?
The doctor may decide to perform a balloon angioplasty.

Till a patient can be got to the hospital for this treatment, what is the first aid that should be given?

The patient should be alert to the symptoms of a heart attack:
Squeezing pain in the centre of the chest lasting for more than a few minutes is a typical sign. Pain may radiate to the shoulders, arms and neck. Patient may also sweat and experience nausea.
It is important to get help immediately. He should be rushed to the hospital.
The patients can chew or swallow a tablet of aspirin as soon as he gets the pain.

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