I'd thrombolyse too. I know the evidence is not as convincing for right
sided as it is left sided infarcts.
What was the pain-to-presentation time?
Simon Odum
Associate Specialist
North Bristol ED
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Bruce Martin
Sent: 17 April 2004 09:25
To: [log in to unmask]
Subject: thrombolysis question
60 year old man, previously well attends with classical presentation for
MI.
No haemodynamic compromise. 12 lead ECG shows isolated ST elevation in
V1
and III. No ST depression. No contraindications for lysis.
Right sided chest leads show ST elevation from V1R to V6R. (Not attached
ECGs due to file size but can email these on request)
No problem with thrombolysing posterior infarcts, but in a patient with
seemingly isolated right ventricular infarct with no compromise, what
are
the feelings of the group?
Possible options:
1. thrombolyse anyway as regional infarction
2. Wait to see if ST elevation in 2 consecutive leads develops
3. Treat as ACS/ NSTEMI
4. PTCA - yeah, right. Might win the lottery this weekend too!
5. Other
We thrombolysed by the way.
Bruce Martin
SpR Emergency Medicine
North West Region
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