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[Elevation of ST segment and Bezold Jarisch reflex as evidence of early post-thrombolysis reperfusion]
E A Sampó1, J Martínez Martínez, J H Casabé
1Unidad Coronaria, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
Insights
Early recognition of successful thrombolysis in acute myocardial infarction (AMI) is crucial. Identifying early coronary reperfusion signs like ST segment changes and enzyme elevation guides treatment decisions for AMI patients.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Prognosis in acute myocardial infarction (AMI) hinges on infarct-related artery patency.
- Early assessment of thrombolysis efficacy is vital for timely intervention in AMI cases.
Observation:
- A clinical syndrome of "early coronary reperfusion" shows strong correlation with angiographic findings.
- Key indicators include >50% pain reduction, >50% ST segment depression, and early CPK elevation.
- Additional signs include Bezold Jarisch reflex (bradycardia, hypotension) and ST segment elevation during thrombolysis.
Findings:
- A 41-year-old male with anterior AMI experienced unstable angina.
- Treatment with Streptokinase (STK) resulted in ST segment changes, bradycardia, hypotension, and acute heart failure that resolved.
- These signs, including ST segment elevation during infusion, indicated successful thrombolysis.
Implications:
- Early identification of successful thrombolysis can optimize treatment strategies for AMI.
- Recognizing reperfusion syndromes aids in managing complex cardiac events.
- This case highlights the importance of monitoring specific clinical and electrocardiographic markers post-thrombolysis.
Abstract:
The prognosis of patients with acute myocardial infarction (AMI) depends on the patency of the infarct-related coronary artery. This is the reason why the early recognition of the result of thrombolysis is very important in order to implement more aggressive studies and more complex treatments in case of failure. A clinical syndrome of "early coronary reperfusion" with an excellent correlation with angiographic data has been identified, characterized by: 1) pain decrease in more than 50%, 2) descent of ST segment elevation of more than 50%, 3) early elevation of creatinine phosphokinase (CPK) enzyme; other signs of reperfusión described are the Bezold Jarisch reflex (bradycardia and arterial hypotension) in patients with inferior AMI, an additional elevation of ST segment during thrombolytic infusion. These two signs of successful thrombolysis were seen early and together in our patient. He was a 41 year old male who had an anterior AMI 4 months before admission to our Coronary Care Unit with diagnosis of unstable angina (rest angina). After 10 hours he began with intensive precordial pain of 30 minutes with 2 mm of ST segment elevation in inferior leads. Streptokinase (STK) (1,500,000 units) by infusion was administered during 45 minutes; at 30 minutes of infusion the patient had an increase of ST segment elevation in the same leads which reached 3 mm and decreased to basal line after 2 hours. He also had bradycardia and hypotension which improved with atropine 1 mg IV. An episode of acute heart failure (confirmed by clinical, radiological and hemodynamic data) resolved just before the end of STK infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
