title: PE with ST-segment elevation in leads V1-3 and AVR treated successfully by catheter directed high-dose bolus thrombolytic therapy during CPR.
abstract: A 55-year-old man presented with the emergency department after having a short syncopal episode and angina during the exertion for 1 month. His initial electrocardiogram showed minimal ST-segment changes on precordial leads. While waiting for the laboratory tests, abruptly, the patient went into cardiopulmonary arrest. After a short resuscitation, a new electrocardiogram revealed ST-segment elevations in leads V1-3 and AVR, mimicking an anteroseptal myocardial infarction. Although, the angiography showed severe coronary artery disease, coronary flow was normal and main branches of pulmonary artery were almost fully occluded by large pulmonary emboli. Recombinant tissue plasminogen activator bolus (25 mg) was given 2 times at 5-minute intervals immediately into pulmonary artery by pig-tail catheter under the cardiopulmonary resuscitation. The patient had an excellent response to high-dose bolus thrombolytic therapy. We conclude that in the case of massive pulmonary embolism with small chance of resuscitation, the catheter-directed high-dose bolus injection of recombinant tissue plasminogen activator could enrich the therapeutical possibilities.
authors.affiliation: Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey. Electronic address: cuneytoprak@hotmail.com.
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Toprak
authors.affiliation: Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Anil
authors.initials: A
authors.lastname: Avci
authors.affiliation: Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Ozturkeri
authors.affiliation: Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet Mustafa
authors.initials: MM
authors.lastname: Tabakci
authors.affiliation: Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Kahveci
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002407:Catheterization, Swan-Ganz / Q000379:methods*; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006323:Heart Arrest / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy; D011655:Pulmonary Embolism / Q000150:complications* / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator