| Delayed thrombolysis in a patient presenting after 12 hours of chest pain, cardiogenic shock and life-threatening arrhythmias. | |
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MedLine Citation:
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PMID: 20120988 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Jorge L Falcon-Chevere; Joanna J Mercado-Alvarado; Yadira Ramos-Arias; Jos? G Caba?as-Rivera |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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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:
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Created Date: 2010-02-03 Completed Date: 2010-04-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7505267 Medline TA: Bol Asoc Med P R Country: Puerto Rico |
Other Details:
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Languages: eng Pagination: 54-7 Citation Subset: IM |
Affiliation:
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Department of Emergency Medicine, UPR School of Medicine, Puerto Rico Health Science Center, San Juan, PR. jfalconc@gmail.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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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:
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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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