[Elevation of ST segment and Bezold Jarisch reflex as evidence of early post-thrombolysis reperfusion].
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)
Sampó
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EA
Unidad Coronaria, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
Martínez Martínez
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J
Casabé
J H
JH
Suárez
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LD
D000328:Adult; D001794:Blood Pressure; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D006339:Heart Rate; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D015425:Myocardial Reperfusion; D011379:Prognosis; D015912:Thrombolytic Therapy
D003402:Creatine Kinase
Supradesnivel del segmento ST y reflejo de Bezold Jarisch como evidencias de reperfusión precoz post-trombolisis.