Mr MT, admitted to an acute hospital with suspected myocardial infarction, says that he had a myocardial infarction 4 years ago and was treated with a drug to ‘dissolve the clot in the coronary artery’. The chest pain started 4 ...Read more
Mr MT, admitted to an acute hospital with suspected myocardial infarction, says that he had a myocardial infarction 4 years ago and was treated with a drug to ‘dissolve the clot in the coronary artery’. The chest pain started 4 hours earlier, and his electrocardiogram shows ST-segment elevation in the anterior leads. What relevance may Mr MT’s previous treatment, present history and findings have to his management on this occasion?
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Thrombolytic drugs are indicated for any patient with acute myocardial infarction, provided the likely benefits outweigh the possible risks. Trials have shown that the benefit is greatest in those with electrocardiogram (ECG) changes that include ST-segment elevation, especially in those with anteriRead more
Thrombolytic drugs are indicated for any patient with acute myocardial infarction, provided the likely benefits outweigh the possible risks. Trials have shown that the benefit is greatest in those with electrocardiogram (ECG) changes that include ST-segment elevation, especially in those with anterior infarction, and in patients with bundle branch block.
The patient has received a thrombolytic, possibly streptokinase, in the past. Mr MT should be asked if he was given a card to carry with him with the identity of the therapy he was given. If
the prior treatment was with streptokinase, prolonged persistence of antibodies to streptokinase may reduce the effectiveness of subsequent treatment.
Therefore, streptokinase should not be used again beyond 4 days of first administration of streptokinase, and urgent consideration should be given to the use of an alternative thrombolytic agent such as alteplase
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