Document Detail


Delayed thrombolysis in a patient presenting after 12 hours of chest pain, cardiogenic shock and life-threatening arrhythmias.
MedLine Citation:
PMID:  20120988     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This 63 years old man presented to the emergency room with chest pain of more than 12 hours duration. The initial electrocardiogram showed as ST segment elevation inferior and right ventricular infarction. He developed signs and symptoms consistent with cardiogenic shock, followed by life threatening ventricular fibrillation and cardiac arrest. After repeated cardio-respiratory resuscitations and successful cardiac defibrillation, thrombolytic therapy was administered followed by clinical and hemodynamic improvements. One-week later cardiac catheterization and coronary arteriography were performed. The study showed 93% obstructive lesion in the proximal right coronary artery, an angioplasty was performed and a stent was placed. After appropriate re-adjustment of medical therapy, the patient was discharged and followed in the outpatient clinic. Although the time frame to administer thrombolytic therapy was over the 12 hours window as suggested by the AHA guidelines1, the potential risks benefits in the casepresented justifed the used of fibrinolytic therapy. Considering the multiple complications that the patient presented, fibrinolytic therapy needs to be considered even after 12 hours of symptoms initiation, particularly when facilities for primary percutaneous coronary interventions are not readily available.
Authors:
Jorge L Falcon-Chevere; Joanna J Mercado-Alvarado; Yadira Ramos-Arias; Jos? G Caba?as-Rivera
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Bolet?n de la Asociaci?n M?dica de Puerto Rico     Volume:  101     ISSN:  0004-4849     ISO Abbreviation:  Bol Asoc Med P R     Publication Date:    2009 Jul-Sep
Date Detail:
Created Date:  2010-02-03     Completed Date:  2010-04-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7505267     Medline TA:  Bol Asoc Med P R     Country:  Puerto Rico    
Other Details:
Languages:  eng     Pagination:  54-7     Citation Subset:  IM    
Affiliation:
Department of Emergency Medicine, UPR School of Medicine, Puerto Rico Health Science Center, San Juan, PR. jfalconc@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use
Angioplasty, Transluminal, Percutaneous Coronary
Chest Pain / etiology*
Coronary Stenosis / complications,  therapy
Dopamine / therapeutic use
Drug Therapy, Combination
Electrocardiography
Fibrinolytic Agents / administration & dosage*,  contraindications,  therapeutic use
Fluid Therapy
Heart Block / drug therapy,  etiology
Humans
Male
Middle Aged
Myocardial Infarction / complications*,  drug therapy,  therapy
Myocardial Reperfusion / methods
Nitroglycerin / therapeutic use
Shock, Cardiogenic / drug therapy,  etiology*,  therapy
Stents
Thrombolytic Therapy* / contraindications
Time Factors
Ventricular Fibrillation / drug therapy,  etiology*
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Fibrinolytic Agents; 55-63-0/Nitroglycerin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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