PHRM3011 Lecture Notes - Lecture 11: Cardiac Output, Angina Pectoris, Skeletal Muscle
Document Summary
At ed pt. will get ecg, blood tests and morphine for pain. 33 troponin = enzyme in cardiac cells, seen when cells are bursting 3-6 hrs after event. Creatine kinase (ck) = enzyme found in heart and skeletal muscle. Raised levels due to: large heart attack (stemi or large nstemi), vigorous exercise, repeated intramuscular damage, skeletal muscle breakdown (rhabdomyolysis) Tx aimed at: reperfusing ischaemic tissue relieving sx. Preventing long term complication (arrhythmias, heart failure) Bare metal stent 2-3 months antiplatelet therapy. Restenosis epithelium growing over the stent too much. Break down clots in coronary arteries through the lysis of fibrinogen bonds. 40-50mg over 30secs risks major bleeding, hemorrhagic stroke. Only breaks down fibrin still need to give antiplatelets and heparin. Pt who presents with stemi within 12hrs of sx onet (doesn"t work after) risk of bleeding (active bleeding, recent head trauma (3 months), suspected aortic dissection risk of intracranial bleeding (stroke (3 months), cancer)
