Related Experiment Videos
Inadvertent thrombolytic therapy for cardiovascular diseases masquerading as acute coronary thrombosis
1Michigan Heart and Vascular Institute, St. Joseph Mercy Hospital, Ann Arbor.
Insights
Administering thrombolytic agents for suspected acute coronary thrombosis can be dangerous if the diagnosis is incorrect. Misdiagnosis of conditions like myocarditis or aortic dissection can lead to serious adverse events.
Area of Science:
- Cardiology
- Emergency Medicine
- Pharmacology
Background:
- Acute coronary thrombosis is a common emergency diagnosis.
- Intravenous thrombolytic agents are a standard treatment for acute myocardial infarction.
- Accurate diagnosis is crucial before administering thrombolytics.
Observation:
- Three patients presenting with symptoms mimicking acute myocardial infarction received thrombolytic therapy.
- Final diagnoses included myocarditis, aortic dissection, and pericarditis.
- One patient with aortic dissection died; others recovered without thrombolytic-related complications.
Findings:
- Cardiac catheterization revealed normal coronary arteries in two patients and aortic dissection in one.
- Review of prior cases shows a high mortality rate (4/5) or tamponade in patients with pericarditis or aortic dissection treated with thrombolytics.
- Inadvertent thrombolytic administration in non-thrombotic cardiac conditions carries significant risks.
Implications:
- Diagnostic uncertainty necessitates cautious approach before thrombolytic therapy.
- Serial electrocardiograms, echocardiography, or urgent cardiac catheterization are recommended when acute myocardial infarction diagnosis is uncertain.
- Improved diagnostic strategies are needed to prevent adverse outcomes from inappropriate thrombolytic use.
Abstract:
We report three cases of inadvertent thrombolytic administration to patients with cardiovascular diagnoses masquerading as acute coronary thrombosis presenting to tertiary care private hospital. Despite a final diagnosis of myocarditis, aortic dissection, and pericarditis, the initial presentation and electrocardiogram were believed to indicate an acute myocardial infarction due to coronary thrombosis. Intravenous thrombolytic agents were administered early in their presentation. Cardiac catheterization in two of the patients revealed normal coronary arteriography and in the third patient confirmed an aortic dissection. The patient with an aortic dissection died while the other two recovered without adverse consequences of the thrombolytic agents. Prior reports of five patients, treated with intravenous thrombolytic agents for suspected coronary thrombosis, who proved to have a final diagnosis of pericarditis or aortic dissection are reviewed. Death or tamponade occurred in four of five. The consequences of inadvertently administering intravenous thrombolytic agents to patients with nonthrombolytic cardiac disorders can be serious. If the diagnosis of acute myocardial infarction due to coronary thrombosis is uncertain, serial electrocardiograms, bedside echocardiography, or urgent cardiac catheterization may be appropriate before administering these agents.