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Rare heart problem decreases in clot-busting era

"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.

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Contact: Richard Merritt
Merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
9-Nov-2004


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