Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Rare heart problem decreases in clot-busting era

10.11.2004


The incidence of cardiac tamponade, an infrequent but potentially fatal event following a heart attack, has not increased despite the widespread use of clot-busting and blood-thinning medications, according to an new analysis by Duke Clinical Research Institute investigators. Since bleeding is the major side effect of such medications, researchers said concerns with increased rates of tamponade existed.



Cardiac tamponade occurs when fluids or blood fill the pericardium, the tough sac enclosing the heart. After an acute heart attack, heart muscle can rupture leading to bleeding into the pericardial sac. Fluids filling the pericardium can cause a rapid drop in blood pressure, leading to loss of consciousness or death. Often a medical emergency, physicians quickly treat it puncturing the pericardium and draining the accumulated fluid.

Prior to widespread use of clot-busting, or fibrinolytic, drugs in the early 1990s, between 4 and 8 percent of acute heart attack patients suffered from cardiac rupture and tamponade.


In their analysis of more than 100,000 patients worldwide, the Duke researchers found that 0.85 percent of acute heart attack patients suffered from tamponade while in the hospital. Duke cardiologist Manesh R. Patel, M.D., presented the results of the analysis Nov. 9, 2004, at the American Heart Association’s annual scientific sessions in New Orleans. "The rates of tamponade in our population of clinical trial patients is similar to if not lower that reported in the pre-fibrinolytic era, and it supports the conclusion that the rate is not significantly higher with these therapies, as was once the general concern," Patel said.

While the researchers found a low incidence of tamponade in general, they cautioned that physicians should still pay close attention to their acute heart attacks patients, since their analysis showed that treatment delays increased the likelihood of cardiac tamponade occurring. "Even though less than 1 percent of patients who undergo fibrinolytic therapy will suffer from cardiac tamponade, it is still a catastrophic event and potentially life-threatening," Patel said. "The time from symptom onset to treatment strongly predicts the development of tamponade, which underscores the need for continuing efforts to rapidly treat patients having an acute heart attack."

For their analysis, the Duke pooled the clinical data from seven multi-center international trials designed to evaluate different fibrinolytic agents from 1990-2002. Out of the population of 102,060 acute heart attack patients who were enrolled in the trials, 865, or 0.85 percent, developed cardiac tamponade during their hospitalization.

On average, the patients who suffered cardiac tamponade tended to be older (71.9 vs. 61.6 years old); were more likely to be female (54 percent vs. 25.1 percent), and were more likely to have suffered an attack on the front wall of the heart (61.9 percent vs. 41.5 percent). Additionally, the researchers found that tamponade patients waited longer – 3.5 hours vs. 2.8 hours – before the initiation of fibrinolytic therapy. "Knowing which patients are more at risk for cardiac tamponade should make it easier for physicians to prevent it from happening," Patel continued. "The strongest predictor that physicians can affect was how long it took for fibrinolytic treatment to begin. The key is providing blood flow to the infarcted heart as soon as possible."

Patel recommends that patients who are at increased risk for tamponade should undergo routine cardiac ultrasound to detect any signs of fluid accumulation in the pericardium. To help physicians, Patel is developing a "nomogram," or health care flow chart, in which physicians taking care of heart attack patients can enter different patient characteristics into an algorithm that can quickly identify patients at the highest risk for tamponade.

Tamponade is also common in patients who suffer from cancer or kidney disease. In these patients, like the heart attack patients, the accumulating fluid in the pericardium puts pressure on the heart, preventing it from filling to capacity with blood. Since too little blood leaves the heart, the body’s tissue are starved of oxygen. That initiates a chain of events that can lead to unconsciousness and death.

The seven clinical trials from which data was drawn were GUSTO-I, GUSTO-IIb, GUSTO-III, ASSENT-II and ASSENT-III, ASSENT-III Plus and Hero-2. Patel’s analysis of the data was supported by the Duke Clinical Research Institute.

Richard Merritt | EurekAlert!
Further information:
http://www.duke.edu

More articles from Health and Medicine:

nachricht Cystic fibrosis alters the structure of mucus in airways
29.06.2017 | University of Iowa Health Care

nachricht Mice provide insight into genetics of autism spectrum disorders
28.06.2017 | University of California - Davis

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making Waves

Computer scientists use wave packet theory to develop realistic, detailed water wave simulations in real time. Their results will be presented at this year’s SIGGRAPH conference.

Think about the last time you were at a lake, river, or the ocean. Remember the ripples of the water, the waves crashing against the rocks, the wake following...

Im Focus: Can we see monkeys from space? Emerging technologies to map biodiversity

An international team of scientists has proposed a new multi-disciplinary approach in which an array of new technologies will allow us to map biodiversity and the risks that wildlife is facing at the scale of whole landscapes. The findings are published in Nature Ecology and Evolution. This international research is led by the Kunming Institute of Zoology from China, University of East Anglia, University of Leicester and the Leibniz Institute for Zoo and Wildlife Research.

Using a combination of satellite and ground data, the team proposes that it is now possible to map biodiversity with an accuracy that has not been previously...

Im Focus: Climate satellite: Tracking methane with robust laser technology

Heatwaves in the Arctic, longer periods of vegetation in Europe, severe floods in West Africa – starting in 2021, scientists want to explore the emissions of the greenhouse gas methane with the German-French satellite MERLIN. This is made possible by a new robust laser system of the Fraunhofer Institute for Laser Technology ILT in Aachen, which achieves unprecedented measurement accuracy.

Methane is primarily the result of the decomposition of organic matter. The gas has a 25 times greater warming potential than carbon dioxide, but is not as...

Im Focus: How protons move through a fuel cell

Hydrogen is regarded as the energy source of the future: It is produced with solar power and can be used to generate heat and electricity in fuel cells. Empa researchers have now succeeded in decoding the movement of hydrogen ions in crystals – a key step towards more efficient energy conversion in the hydrogen industry of tomorrow.

As charge carriers, electrons and ions play the leading role in electrochemical energy storage devices and converters such as batteries and fuel cells. Proton...

Im Focus: A unique data centre for cosmological simulations

Scientists from the Excellence Cluster Universe at the Ludwig-Maximilians-Universität Munich have establised "Cosmowebportal", a unique data centre for cosmological simulations located at the Leibniz Supercomputing Centre (LRZ) of the Bavarian Academy of Sciences. The complete results of a series of large hydrodynamical cosmological simulations are available, with data volumes typically exceeding several hundred terabytes. Scientists worldwide can interactively explore these complex simulations via a web interface and directly access the results.

With current telescopes, scientists can observe our Universe’s galaxies and galaxy clusters and their distribution along an invisible cosmic web. From the...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Plants are networkers

19.06.2017 | Event News

Digital Survival Training for Executives

13.06.2017 | Event News

Global Learning Council Summit 2017

13.06.2017 | Event News

 
Latest News

Nanostructures taste the rainbow

29.06.2017 | Physics and Astronomy

New technique unveils 'matrix' inside tissues and tumors

29.06.2017 | Life Sciences

Cystic fibrosis alters the structure of mucus in airways

29.06.2017 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>