Dysrhythmias and blood pressure changes associated with thrombolysis

Recent technologic advances facilitate salvage of viable myocardium before the process of myocardial infarction is complete. The aim of thrombolytic agents is to restore antegrade flow of blood in occluded coronary arteries. The process of reperfusion may be dysrhythmogenic because of the heterogeneous return of electrical activity in myocardial cells. This study examined the incidence and type of dysrhythmia occurrence and the associated changes in mean arterial blood pressure (MAP) during infusion of tissue-type plasminogen activator (TPA). A retrospective chart review of 41 subjects showed that 80% of subjects experienced dysrhythmias during TPA therapy. The most common dysrhythmia was sinus bradycardia, followed by idioventricular/accelerated idioventricular rhythm, ventricular premature beats, and ventricular tachycardia/fibrillation. There was a significant difference between MAP changes when there were no dysrhythmias and MAP changes when dysrhythmias occurred (p less than 0.05). The largest change in MAP (-22.71 mm Hg) was observed when dysrhythmias occurred in those subjects with blockage of the left anterior descending artery, although there was no statistically significant difference in changes in MAP among the groups of different sites of blockage (p greater than 0.05).