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Symptom onset and treatment in acute myocardial infarction

Mahmoud, K., 2014, [S.l.]: [S.n.]. 238 p.

Research output: ThesisThesis fully internal (DIV)Academic

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  • Karim Mahmoud
This thesis describes the role of symptom onset and symptom onset to treatment time in the treatment of a heart attack. The first part focuses on symptom onset. Heart attacks and sudden cardiac death are known to have a predisposition for the morning hours. We show that sudden occlusion of a stent after angioplasty also tends to occur in the morning and that morning heart attacks are often smaller.
Symptom onset to treatment time is investigated in the second part. The finding is presented that patient-reported symptom onset time is typically later than can be expected from in-hospital blood measurements, suggesting that actual heart attack onset is earlier than reported by patients. Patients with a heart attack based on a totally occluded coronary artery benefit from prehospital diagnosis to expedite in-hospital angioplasty. The established ambulance protocol to facilitate this is evaluated. When coronary occlusion is subtotal, medical pretreatment is common. We determine that the optimal timing of any further invasive management by means of angioplasty or bypass surgery is after 20-40 hours of pretreatment.
The last part focuses on in-hospital treatment. We show that thrombus aspiration before angioplasty in patients with an occluded stent improves restoration of blood flow to the heart muscle and that patients with a heart attack and narrowing of multiple coronary arteries benefit most of a staged approach with multiple angioplasty procedures. Finally, we prove the hypothesis that clinical studies evaluating novel therapies for cardiovascular diseases are often unable to draw firm conclusions from their results.
Translated title of the contributionOptreden van klachten en behandeling in het acute myocardinfarct
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
Supervisors/Advisors
Award date3-Dec-2014
Place of Publication[S.l.]
Publisher
Print ISBNs978-90-367-7203-7
Electronic ISBNs978-90-367-7204-4
Publication statusPublished - 2014

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