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8. The acute coronary syndromes: myocardial infarction and unstable angina
Author(s) -
Thompson Peter L,
Stobie Paul
Publication year - 1999
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1999.tb123573.x
Subject(s) - cardiology , medicine , myocardial infarction , coronary thrombosis , unstable angina , angina , thrombosis , acute coronary syndrome
Synopsis The “golden hour” is the first hour after total coronary occlusion, when ischaemia has occurred, but irreversible necrosis has not; the adage “time is muscle” emphasises the urgency of action. Coronary thrombolysis is highly effective and should be considered immediately when total coronary occlusion is suspected; coronary angioplasty can achieve even more effective reperfusion in skilled hands. The progressive nature of myocardial necrosis presents opportunities for reperfusion up to 12 hours after coronary occlusion. The dynamic interaction of the unstable plaque, coronary thrombosis and varying myocardial oxygen demand makes admission to a coronary care unit mandatory for all patients suffering an unstable coronary syndrome. The site of coronary thrombosis must be stabilised to avoid continuing ischaemia; this may require coronary angioplasty with stenting. Consider antiplatelet, lipid‐lowering and ß‐blocker therapy in every patient who has survived an acute coronary syndrome, and angiotensin‐converting enzyme inhibitors in those with extensive infarction.Aggressive treatment of myocardial thrombosis can save lives and prevent lifelong disability