Both cases today are patients with myocardial infarction, one with thrombolysis and one with stents.
But in the end, the patients were not able to rescue them.
You will definitely ask, why are the patients all in the hospital, have done the treatment of opening blood vessels, why are there still no people?
Case 1:
The patient, a 66-year-old woman, who had sudden chest pain for 3 hours, was diagnosed with acute myocardial infarction and was immediately treated with thrombolysis.
After 1 hour of thrombolysis, ecG, patient symptoms and other indicators did not indicate the opening of the patient's blood vessels, that is, the patient's thrombolysis was not successful. There are 2 main reasons why thrombolysis is unsuccessful:
1. The earlier the thrombolysis, the higher the success rate, generally the best effect is within 3 hours, and the probability of successful thrombolysis after 6 hours is very low. The patient went to the hospital after 3 hours of chest pain, and the start of thrombolysis was already 4 hours later, so the thrombolysis was not successful.
2. Thrombolysis is actually infusion, but the infusion is a thrombolytic drug, and the success rate of thrombolysis to open blood vessels is much lower than that of stents.
3 hours after thrombolysis, the patient dies.
Case 2:
The patient, a 55-year-old man, sudden chest tightness and holding his breath for 4 hours, was diagnosed with acute extensive anterior wall myocardial infarction after admission, when the blood pressure was 80/40mmHg, which was hypotensive shock.
The blood vessels were opened, stents were implanted, and blood flow was restored, but the patient had severe cardiogenic shock and died of heart failure 18 hours after being returned to the intensive care unit.
Stents can only open blood vessels to restore blood flow. But before the blood vessels are opened, the myocardial necrosis that has been caused is irremediable, so even if the blood vessels are opened later, the patient is still due to complications of myocardial infarction, severe heart failure, and eventually lead to death.
Factors that determine the prognosis of a patient with myocardial infarction:
1. The area of myocardial infarction
The heart has three large blood vessels, but relatively speaking, the left front of the heart is larger and more important, and generally speaking, this blood vessel is blocked, called acute anterior wall myocardial infarction. After this blood vessel is blocked, then there will be more necrosis of the heart muscle, and the risk of death will be relatively greater.
Of course, even if the same blood vessel is blocked in the opening, it is still the middle section, or the last section, naturally it is different. Just like a big tree, if it breaks from its roots, it will undoubtedly die, but if it is broken from the treetops, the impact is not very large. The natural necrosis area from root blockage is large and the risk of death is high; from the peripheral blockage, the natural necrosis area is small and the risk of death is low.
So the more area of myocardial infarction, the higher the risk of death.
But none of us can decide which blood vessel the myocardial infarction occurs in, and where it occurs!
2. The time of myocardial infarction
The same is blocked in the front branch of the opening, some people 1 hour to the hospital, open the blood vessels, rescued; some people do not go to the hospital for 4 hours, then may be sudden death outside the hospital. Even if you can get to the hospital in 4 hours, even if you open your blood vessels, you are very likely to have heart failure and shorten your life. Just like the second patient, the opening of the anterior descending branch is blocked, the heart muscle is necrotic in a large area, the heart is severe, and finally dies.
Because the longer myocardial infarction lasts, the larger the area of myocardial necrosis, the higher the risk of sudden death.
Only by racing against the clock and opening the blood vessels as soon as possible can we save more heart muscle and save more lives.
Although we can't control which part of the blood vessel is blocked by myocardial infarction, we can detect and open the blood vessel early, so as to save time and strive for golden treatment time, thereby improving the chance of survival.
So we have been popular science: chest pain lasts for 15 minutes without relief, to suspect myocardial infarction, immediately dial 120!
3. Luck of myocardial infarction
Of course, even if it is the same blood vessel, the same part, at the same time, at the same time, there will be some differences, such as: age, gender, underlying diseases, medical conditions and so on.
But that's almost all of us can't change.
In the entire treatment process of acute myocardial infarction, the only time that can be controlled by people is the time: the time when the patient dials 120, the time when the patient's family signs, the time when 120 arrives, the time when the hospital catheterization room is treated, the time when the doctor opens the blood vessels, etc., are all factors that determine the prognosis of the patient.
So, in the face of myocardial infarction, time is life!
The latest data from 253 chest pain centres nationwide:
Data analysis of patients with acute myocardial infarction in 23 provinces and 253 chest pain centers in mainland China:
The total hospitalization of patients who arrived at the hospital for myocardial infarction was 4.0%, which means that 4 of the 100 patients who arrived at the hospital with myocardial infarction, even after formal treatment, died because the condition was too serious.
In level 2 hospitals, the mortality rate is relatively higher, reaching 4.1%, and the mortality rate in level 3 hospitals is relatively lower at 2.3%.
4 early is the key to the treatment of myocardial infarction:
Therefore, it is not that everything will be fine when you arrive at the hospital, myocardial infarction is very critical, and it must be done early: early prevention, early detection, early diagnosis, early opening of blood vessels!
1. Only early prevention can reduce the risk of myocardial infarction, no myocardial infarction, naturally there is no risk of death caused by myocardial infarction. Early prevention is to live a healthy life + control the three highs.
Adhere to the long-term healthy diet (low salt, low oil, low sugar as the principle, reduce the staple food of fine grains, appropriately increase the proportion of coarse grains, and increase the proportion of fruits and vegetables. ), adhere to exercise, control weight, stay away from tobacco and alcohol, regular work and rest, etc.; monitor blood pressure, blood sugar, blood lipids, if there is hypertension, diabetes, hyperlipidemia must be actively and formally controlled. That's early prevention!
2, early detection, is to understand that the precursor of myocardial infarction is angina, to have a little knowledge of angina, early detection of angina, in order to diagnose early, after formal treatment, then you can prevent myocardial infarction and avoid myocardial infarction.
Of course, the second layer of early detection means that early detection of myocardial infarction, because many people even if they have myocardial infarction, they do not think so, because they do not understand what is myocardial infarction, often delayed for a long time, or lead to sudden death, or miss the best rescue time.
3. Early diagnosis (simple understanding of myocardial infarction is angina that lasts for 20 minutes and still does not relieve angina, angina time is slightly shorter, only a few minutes or so, and myocardial infarction time is very long, has not been relieved. Angina may be chest pain, precordial pain, chest tightness, sweating, or headache, toothache, abdominal pain, back pain, shoulder pain, neck pain, or pharyngeal tightening, fatigue, cold sweat and other symptoms. For specific methods of judging angina or myocardial infarction, please consult @Cardiovascular Dr. Wang and other related popular science articles. ）
4. Early opening of blood vessels means that once myocardial infarction is diagnosed, it is necessary to cooperate with the doctor to open the blood vessels immediately, so that the early opening of blood vessels can save more myocardium and greatly reduce the risk of death.
In short, myocardial infarction is a very critical disease, even if you can successfully reach the hospital, it does not mean that you can be 100% rescued. It can only be said that if you arrive at the hospital early, the chance of being rescued will increase, so for myocardial infarction, the best way is still prevention!