Neutrophil adhesion and activation during systemic thrombolysis in acute myocardial infarction

Assessment of reperfusion following thrombolysis with mean fibrillation and amplitude spectrum area in patients with sustained ventricular fibrillation

BACKGROUND

Improved microcirculatory reperfusion in patients with ventricular fibrillation (VF) enhances the electrical activity of the fibrillation process and increases the likelihood of successful defibrillation.

METHODS

Changes in amplitude spectrum area (AMSA) and mean fibrillation (MF) in patients with sustained VF were analysed after administration of rt-PA variant tenecteplase in out-of-hospital cardiac arrest (OHCA) during cardiopulmonary resuscitation (CPR).

RESULTS

A total of 69 ECG sequences from nine patients were evaluated. Patients who received tenecteplase showed significantly longer duration of VF (p = 0.016). While AMSA declined significantly during CPR (p = 0.001), MF did not differ between groups. There were two survivors in the treatment group and one in the control group.

CONCLUSION

When tenecteplase was administered during CPR, VF lasted significantly longer than in controls. Changes in MF and AMSA did not indicate improved myocardial perfusion in patients who received tenecteplase during CPR.

Reperfusion injury after focal myocardial ischaemia: polymorphonuclear leukocyte activation and its clinical implications

The only way to rescue ischaemic tissue is to re-instate the oxygen supply to the tissue. However reperfusion of the ischaemic area not only oxygenates the tissue but also initiates a cascade of processes, which may in some cases result in temporary dysfunction of the myocardium. In order to devise protective measures, it is essential to understand the mechanisms and the triggers of this reperfusion phenomenon. In this review we will mainly focus on the inflammatory response caused by reperfusion. We will cover the different steps of polymorphonuclear leukocyte activation and will briefly discuss the molecular biology of the receptors involved. The currently used pharmacological medications in acute cardiology will be reviewed and in particular their actions on polymorphonuclear leukocyte activation, adhesion and degranulation. This review is a compilation of the current knowledge in the field and the therapeutic progress in the prevention of reperfusion injury made today.