Heart attack

Guidelines are used to determine if someone is a good candidate for using tPA. According to the American College of Cardiology (ACC), each year 800,000 persons in the United States have acute heart attacks and 213,000 die. Those who die from heart attacks generally die within 1 hour from the initial onset of symptoms and sometimes before they get to the hospital. Many national groups are working together to decrease the time it takes to get people having a heart attack to facilities where tPA can be given. The sooner thrombolysis therapy is given, the better the outcome. The window of opportunity is a very short amount of time.

For a person having an acute heart attack, tPA works by dissolving a major clot quickly. The clot is most likely blocking one of the coronary arteries that normally allows blood and oxygen get to the heart muscle. By dissolving the clot, the blood is able to start flowing again to that area of the heart. If the blood flow to the heart is started again rapidly, it may prevent long-term damage to the heart muscle and may even stop an event that could have been fatal.

Physicians base their decisions about whether to give tPA for a heart attack on many factors, including results of an ECG test. Other factors used to determine if someone is a good candidate for tPA include age, medical history, gender, history of previous heart attack, history of diabetes, history of low blood pressure or increased heart rate, and if the person is elderly (older than 70 years).

Generally, tPA will not given if the person has had a recent head injury, trauma, surgery, bleeding problems, uncontrolled high blood pressure, bleeding ulcers, or pregnancy.

Stroke

Close to 80% of all strokes are ischemic strokes, caused when blood clots form in one place in the body then travel to a smaller blood vessel in the brain, blocking the blood flow to that part of the brain. For strokes of this nature, tPA can help dissolve the clot quickly. Often, tPA can limit the amount of permanent disability that can result from an ischemic stroke, especially if given within 3 hours of the initial symptoms of the stroke.

tPA is not given if someone is having a hemorrhagic stroke or a stroke caused by bleeding in the brain, because this could worsen the stroke by causing increased bleeding. Ischemic strokes often occur when a person is relatively tranquil or calm. Hemorrhagic strokes often occur during some sort of physical exertion. Hemorrhagic strokes generally have more profound symptoms at the very beginning of the stroke, whereas the symptoms with an ischemic stroke sometimes develop over a longer period of time and may not be as severe.

In some cases the diagnosis of the actual type of stroke may be difficult and the risk of bleeding from tPA is a concern. Generally, the benefits of receiving it outweigh the risks.

Risks

Hemorrhage or bleeding is the most common risk associated with the administration of tPA therapy. This is true for both stroke and heart attack patients. When given to patients who have been diagnosed with a heart attack, there is a risk that they could have a stroke or an intracranial hemorrhage as a complication of the therapy. With stroke patients, there is also a possibility of intracranial hemorrhage.

Contact a healthcare provider or call 911 Emergency Service

The key for people suffering from a heart attack or a stroke is recognizing that both conditions are medical emergencies. The sooner transportation and treatment with tPA takes place for acceptable candidates, the better the chance that person has for a good outcome.

Please refer to the stroke and heart attack articles for specific symptoms for both conditions. If you suspect you or someone you know is suffering from symptoms of a heart attack or stroke, you should seek help immediately.

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