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Threatened reinfarction. Effective therapy using streptokinase with reversal of cardiogenic shock
W R Andrews1, J M Arnold, W J Sibbald
1Division of Critical Care Medicine, University of Western Ontario, London, Canada.
Insights
Thrombolytic therapy, using streptokinase, effectively reversed cardiogenic shock in a patient with inferior myocardial infarction presenting over nine hours after symptom onset. This challenges the strict time and location criteria previously limiting its use.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Background:
- Thrombolytic therapy is a standard treatment for acute myocardial infarction.
- Current guidelines often restrict thrombolytic therapy to cases with ischemic pain onset within 4 hours.
- Treatment is frequently limited to anterior infarctions, based on historical data.
Observation:
- A patient presented with cardiogenic shock secondary to inferior myocardial infarction.
- The patient experienced chest pain and ST elevations for over 9 hours prior to treatment.
- Streptokinase therapy was administered despite the extended time frame and infarction location.
Findings:
- The patient showed a remarkable reversal of cardiogenic shock following streptokinase administration.
- This outcome was observed despite the prolonged duration of symptoms and the inferior location of the infarction.
- The case suggests potential benefits of thrombolysis beyond established restrictive criteria.
Implications:
- This case challenges the conventional time and location restrictions for thrombolytic therapy in acute myocardial infarction.
- It highlights the potential efficacy of streptokinase in selected patients with prolonged symptoms and inferior infarctions.
- Further investigation into expanded criteria for thrombolytic therapy in myocardial infarction is warranted.
Abstract:
Thrombolytic therapy has an established niche in the treatment of acute myocardial infarction. One view, often rigidly held, is that this therapy should be attempted only if ischemic pain is present for less than four hours. Additionally, treatment is often reserved for those with an anterior infarction, a subgroup that did well in early reports. This case report demonstrates an impressive reversal of cardiogenic shock after streptokinase therapy in a patient who experienced an inferior infarction. His chest pain and ST elevations were present for more than nine hours at the commencement of treatment.