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Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
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In cardiovascular health, antianginal drugs combat angina pectoris — a condition marked by chest pain owing to diminished blood flow to the heart.
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Prehospital Thrombolysis: A Manual from Berlin
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Pre-hospital transdermal glyceryl trinitrate for transient ischaemic attack: Data from the RIGHT-2 trial.

Jason P Appleton1,2, Mark Dixon2,3, Lisa J Woodhouse2

  • 1Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK.

European Journal of Neurology
|October 11, 2024
PubMed
Summary

Pre-hospital glyceryl trinitrate (GTN) did not improve functional outcomes for transient ischaemic attack (TIA) patients. This treatment was associated with increased death or dependence compared to sham treatment.

Keywords:
blood pressureclinical trialstroketransient ischaemic attack

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Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Emergency Medicine

Background:

  • Ambulance trials are evaluating interventions for suspected stroke.
  • Transient ischaemic attack (TIA) patients may present with resolving symptoms.
  • The RIGHT-2 trial assessed glyceryl trinitrate (GTN) in TIA patients.

Purpose of the Study:

  • To evaluate the safety and efficacy of transdermal GTN in TIA patients.
  • To determine the effect of GTN on functional outcomes in TIA.
  • To assess GTN's impact on death or dependence in TIA.

Main Methods:

  • A multicentre, randomized, sham-controlled, blinded-endpoint trial (RIGHT-2).
  • Patients with presumed ultra-acute stroke within 4 hours received transdermal GTN or sham.
  • Modified Rankin Scale (mRS) at 90 days was the primary outcome.

Main Results:

  • 109 patients (9.5%) were diagnosed with TIA.
  • GTN lowered blood pressure but did not improve mRS scores.
  • GTN was associated with increased death or dependence (OR 3.86, 95% CI 1.09-13.59).

Conclusions:

  • Pre-hospital GTN did not improve functional outcomes in TIA patients.
  • Transdermal GTN showed no benefit and potentially increased harm in TIA.
  • Further research is needed on GTN's role in TIA management.