Unrecognized major bleeding following thrombolysis for acute myocardial infarction presenting with syncope.
Complete atrioventricular block and syncope sometimes are the presenting signs of acute myocardial infarction. In a presyncopal attempt to assume sitting position, the patient may fall and suffer consequent trauma. Once in hospital, this sequence of events may be overlooked by both the patient and admitting physicians. Moreover, physical examination initially may not be revealing. We report on two such patients who developed massive subcutaneous bleeding following thrombolytic and heparin treatment. We conclude that these patients constitute a specific group with a relatively high risk of trauma and bleeding at the gluteal region following thrombolytic therapy. Special attention must be given to these patients.
Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, Israel.
N
N
Cohen
R
R
Zaidenstein
A
A
Blatt
D A
DA
Sarafian
I
I
Litinsky
D
D
Modai
D000058:Accidental Falls; D000368:Aged; D006406:Hematoma / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy*; D013300:Streptokinase / Q000627:therapeutic use; D013575:Syncope / Q000209:etiology*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D013300:Streptokinase; D010959:Tissue Plasminogen Activator