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- 66 bpm
- Ectopic atrial rhythm
- Inverted P waves in inferior leads
- PR - Normal
- QRS - Normal
- Marked ST elevation leads II (5mm), III (6mm), aVF (6mm)
- ST Depression leads I, aVR, aVL, V1-6
- T wave inversion leads aVR, aVL, V1-2
- Biphasic T wave leads V3-5
- Inferior STEMI
- Likely posterior extension
What are the contraindications to thrombolysis ?
If you work in a metropolitan or tertiary center you probably send all your STEMI's for urgent angiography but it remote and rural centers thrombolysis must be considered.The following list is taken from the Australian Resuscitation Council Guideline 14.3 'Acute Coronary Syndromes: Reperfusion Strategy'.
|Contraindications to thrombolysis in STEMI|
ARC Guideline 14.3
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What agents can you use and how are they given ?
- Streptokinase 1.5 million units iv over 60 minutes
- Alteplase initial iv bolus plus variable dose infusion over 90 minutes
- Reteplase 10 units iv over 2 minutes followed 30 minutes later by a further 10 units iv over 2 minutes
- Tenecteplase 30-50mg iv bolus depending on patient's weight
What are the complications of thrombolysis for STEMI ?
- Haemorrhage ~10%
- Intracranial haemorrhage ~0.8%
- Allergic reaction / anaphylaxis
- Myocardial rupture if thrombolysis given greater than 12 hrs onset ischaemia
- Re-perfusion arrhythmias
- Re-occlusion / Re-infarction
- Bone pain with streptokinase
Life in the Fast LaneTextbook
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.