CARDIOLOGY

Recognize the limitations of thrombolysis.

Explanation:

Thrombolysis may be used upto 12 hours after the onset of the MI symptoms. It is approximately 80% effective but as time goes by more muscle dies and less remains salvageable. The clot in the coronary also becomes more stable with a lesser chance to break.(Time is muscle)

This success rate seen early-climbs down as time goes by and re-occlusions occur.

There are some important contraindications to thrombolysis and must be remembered. Systolic BP>180 OR DBP>100, active peptic ulcer disease, History of hemorrhagic stroke, Major surgery or invasive procedure within the last 2 weeks or prolonged CPR (generally >15 minutes)

Within 90 minutes  of administration of thrombolysis one must see the ST elevation reduced to half the amount of initial elevation. If this does not occur - take the patient to the cath lab immediately for rescue angioplasty - provided you strongly feel that this is an MI.