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Explain The Pathophysiology For Myocardial Infarction And Tissue Plasminogen Activator Drug, Relating The Drug Target To The Compromised Or Diseas

1167 words - 5 pages

Myocardial infarction is a medical term commonly known as a heart attack.1 According to the British Heart Foundation, there is approximately 103,000 heart attacks in the United Kingdom each year and every seven minutes someone dies of a heart attack.2 Before a suitable treatment can be found, we must understand the factors that cause myocardial infarction and the pathophysiology of the disease. From there we are then able to determine the effective treatments to be given for this disease.

By definition, infarction is an area of ischemic necrosis caused by blockage of the arterial supply or venous drainage to the myocardium.3 Myocardial infarction is a form of ischemic heart disease where ...view middle of the document...

Thrombosis is the inappropriate activation of blood clotting in a vessel with flowing blood resulting in the formation of a thrombus.3,4 The first step towards the formation of the clot is damage to the endothelium which exposes collagen in the intima and media of the vessel wall.4 This causes platelets to attach itself to the site of damage(platelet adhesion) triggering the coagulation cascade which forms a clot. The diagram below shows the clotting cascade consisting of two pathways namely intrinsic and extrinsic pathway which is controlled by a total of thirteen coagulation factors before a clot is formed.3,9 The final stages of the coagulation cascade is where the inactive enzyme prothrombin is converted in to its active form thrombin with the help of factors Xa, Va, PL and calcium ions. Thrombin then converts fibrinogen which is soluble in to fibrin an insoluble substance. Factor XIIIa then causes the cross-linking of fibrin strands which helps trap platelets and other blood cells thus forming a thrombus.10

Figure 2 : The coagulation cascade11

From the paragraph above, it is clearly seen that the thrombus plays a big role in myocardial infarction therefore one of the methods of treating this disease is by removing the thrombus occluding the artery. This can be done with thrombolytic therapy whereby a thrombolytic drug such as tissue plasminogen activator (t-PA) is used to remove the blood clot. Tissue plasminogen activator (t-PA) is a serine protease which is crucial in the regulation of intravascular thrombolysis.12 The t-PA drug works by activating plasminogen in the blood to form the plasmin enzyme which promotes the breakdown of fibrin and fibrinogen in to degradation products.4,13 This causes the thrombus occluding the artery to lyse restoring some blood flow to the myocardial cells thus preventing necrosis. The t-PA drug can be administered intravenously or intra-arterially and have been proven to reduce the mortality rate when administered within 12 hours after the heart attack.14
It is seen from the content above that myocardial infarction is generally caused by blockage of a coronary artery leading to death of myocardium. However, damage to the myocardium can be reduced by administering t-PA to dissolve the clot thus restoring blood flow. Benefit from the t-PA drug is time dependent therefore the sooner the drug is administered after onset of the heart attack, the more effective the drug.13 Further research needs to be taken to improve effectiveness of the t-PA drug for future...

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