Cardiovascular Disease: NSTEMI, STEMI, and Tenecteplase - Report

This report examines Non-ST-elevation myocardial infarction (NSTEMI), a type of heart attack, and its characteristics, risk factors, and diagnostic methods. It then delves into the use of Tenecteplase, a tissue-plasminogen activator, in treating ST-elevation myocardial infarction (STEMI). The report explains the mechanism of action of Tenecteplase, including its binding to fibrin-rich clots and the subsequent cleavage of plasminogen to form plasmin, which degrades the thrombus' fibrin matrix. The dosage, administration, and advantages of Tenecteplase, such as its prolonged half-life and fibrin-specific action, are also discussed. The report highlights the benefits of Tenecteplase in overcoming logistical challenges and offering reperfusion to STEMI patients. References in APA 7th edition are included.

CARDIOVASCULAR
DYSFUNCTION

TABLE OF CONTENTS
1. NSTEMI..................................................................................................................................3
2. Tenecteplase in treating STEMI..............................................................................................3
REFERENCES................................................................................................................................5

1. NSTEMI
NSTEMI is basically a kind of heart attack which stands for Non-ST-elevation myocardial
infarction. It is also known as non-STEMI which is a medical term for heart attack. ST describes
the ST segment which is a portion of the heart tracing of EKG which is used in diagnosing a
heart attack (Sanchis and et.al., 2019). Its risk factors include physical inactivity, high cholesterol
or blood pressure, smoke, obese or overweight etc. Its symptoms include the dizziness, shortness
of breath, discomfort in chest, nausea, sweating, pressure, light-headedness etc. It can be
diagnosed through an ECG or blood test. In ECG, the characteristics of NSTEMI found are
partial blockage of coronary artery, no progression to Q wave and T-wave inversion or depressed
ST wave (Kaura and et.al., 2020).
2. Tenecteplase in treating STEMI
Tenecteplase is basically a tissue-plasminogen activator which is fibrin-specific. It helps in
binding itself with the fibrin rich clots and also helps in cleaving the Arg/Val bond in the
plasminogen in order to form plasmin. It in turn degrades the thrombus’ fibrin matrix which
leads to exerting the thrombolytic action. This helps in eliminating the blood clots of the
blockages in arteries which causes myocardial infarction.
The tenecteplase takes the responsibility to bind with the fibrin rich clots through the Kringle 2
domain and fibronectin finger-like domain. The protease domain then performs the function of
cleaving the Arg/Val bond for forming the plasmin in the plasminogen. Plasmin helps in
degrading the fibrin matrix of thrombus which exerts the thrombolytic action. It is dosed
according to the weight of the body. The people whose weight is less than 60 kg, they are given
30 mg of this medication and the people having less than 50 kg weight are given with 50 mg of
its dosage. It is given as a single bolus over 5 to 10 seconds. It STEACS within 12 hours
(Morales-Ponce and et.al., 2019). TNKase is mainly consists of the alteplase molecule which is
having molecular weight of about 65,000 kD. Its mutation of the sequence and the substitution
by Asn helps in prolonging the half life and helps in increasing the resistance to the inhibitor of
plasminogen activator. It also has the highest degree of the binding and specificity of fibrin
which is basically reducing the propemsity for leading to the non-cerebral bleeds as the lytic
activity is bounded to the plasmin on the surface of fibrin. This helps in avoiding of the
breakdown of fibrinogen. This helps to solve the problem of people with STEMI as it allows
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single bolus infusion and prevents the inactivation of drugs at the platelet-rich coronary
thrombosis’ site (Bawaskar, Bawaskar and Bawaskar, 2019). Tenecteplase also has some anti-
platelet properties which is applicable to vivo as well as vitro. The thrombolytic potency of this
medication is 3-fold greater than that of the alteplase. This is why, the fibrinolytic strategy based
on this medication is offered to most of the health care settings and systems which helps in
overcoming the huge logistics problems including the STEMI. This is considered as the real
opportunity for offering the reperfusion to the patients with STEMI.
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REFERENCES
Books and Journals
Bawaskar, H. S., Bawaskar, P. H., & Bawaskar, P. H. (2019). Preintensive care: thrombolytic
(streptokinase or tenecteplase) in ST elevated acute myocardial infarction at peripheral
hospital. Journal of family medicine and primary care. 8(1). 62.
Kaura, A. & et.al., (2020). Invasive versus non-invasive management of older patients with non-
ST elevation myocardial infarction (SENIOR-NSTEMI): a cohort study based on
routine clinical data. The Lancet. 396(10251). 623-634.
Morales-Ponce, F. J. & et.al., (2019). Intracoronary tenecteplase versus abciximab as adjunctive
treatment during primary percutaneous coronary intervention in patients with anterior
myocardial infarction. EuroIntervention: journal of EuroPCR in collaboration with the
Working Group on Interventional Cardiology of the European Society of
Cardiology. 14(16). 1668-1675.
Sanchis, J. & et.al., (2019). Invasive versus conservative strategy in frail patients with NSTEMI:
the MOSCA-FRAIL clinical trial study design. Revista Española de Cardiología
(English Edition). 72(2). 154-159.
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