Located on the 1st floor of building B, the Interventional Cardiology Hemodynamics Unit has twenty beds with rooms of three beds. All rooms have a private bathroom, air conditioning, television and a cupboard for patients’ clothes.
In Italy ischemic heart disease affects 5% of the population with 2,000,000 patients and 350,000 new cases each year.
Acute myocardial infarction with STsegment elevation is the most serious manifestation of heart disease. In patients affected by the disease one of the three main branches that carry blood to the myocardium becomes blocked completely because an atherosclerotic plaque ulcers and causes the formation of a thrombus into the blood vessel. The myocardial tissue that is downstream of the occluded artery does not receive any more blood (nor, therefore, oxygen and nutrients), so the patient can die within a few hours. Complications of the disease are many and range from heart failure to death.
Nowadays the best treatment is to reopen the blood vessel as quickly as possible and restore blood flow to the area that was going to necrotize.
The reopening of the blood vessel or reperfusion therapy can be done in two ways:
- Drug: systemic thrombolysis
- Mechanics: primary angioplasty
Thrombolysis unfortunately is only effective in 5060% of cases and is associated with a significant number of potentially serious bleeding complications which may be lethal.
Primary angioplasty instead is effective in 98% of cases and allows a full reopening of the vessel. Being a procedure performed in highrisk patients and in emergency it is not without complications but clinical studies of thousands of patients have clearly demonstrated its efficacy, safety and superiority over thrombolysis. Today it is considered the best treatment by the latest European and American guidelines.
The indications and timing for primary angioplasty are the following:
- When you can do so within 90 minutes of first medical contact
- Cardiogenic shock within 18 hours of the onset of the same.
- STEMI at high risk of mortality (congestive heart failure, pulmonary edema, electrical instability).
- Inferior myocardial infarction with left ventricular involvement.
- Late presentation (onset of symptoms for more than three hours).
- When there aren’t signs of reperfusion after 90 minutes from the start of thrombolytic therapy: persistent angina, of ST elevation, hemodynamic deterioration, electrical instability (PTCA rescue).
- Contraindication to thrombolytic therapy.
