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Was this truly an infarct ? Falling asleep as a presenting complaint would certainly be unusual in anotherwise presumably independent and ambulant patient (given the location of the scenario ie: the hairdressers. Was there any other diagnostic evidence of an infarct or was an old ecg available ? Presumably she did have an enzyme rise subsequently in keeping with an infarct and evolving changes on her ecg ? Regards John -----Original Message----- From: Simon Bell [SMTP:[log in to unmask]] Sent: 20 March 2000 10:26 To: [log in to unmask] Subject: ? Thrombolysis. I would be interested in peoples oppinion of the following senario: We had a 93 yr old lady into A+E who presented with a collapse.....she kept "falling asleep" while she was having her hair done, so the hairdresser suggested she came to A+E. There was no history of Chest pain or Diabetes. This lady had an ECG showing an acute inferior infarct of less than 12 hrs old (likly). She was in SR, no failure clinically or on her CXR, and was normotensive. AS a knee jerk reaction she was given aspirin and prepared for thrombolysis with Streptokinase. This lady had had a CVA 6 yrs ago with a right hemiplegia from which she just about remained independant. I was coutious about thrombolysing this lady.....not becouse of her stroke 6 yrs ago, but I questioned the benefit in a lady of this age in terms of added morbidity. I am well aware that the elderly do best from thrombolysis in terms of coronary flow as measured in the TIMI flow studies, but how does that relate to added yrs of life given that this lady's starting age was 93. She was also highly dependant on her left side for her independant state and from a cardiac point of view she was doing very well, probably just a few peri-infarct arrhythmias causing her synptoms in the hairdresser's salon. If thrombolysing her is going to do little in terms of added yrs of life, why risk making her dependant by the possibility of an intracranial event. Aspirin alone is still as good as thrombolysis alone. Anyway...after great calm debate she was thrombolysed and was doing well 2-days later... I would like to know: Was I being overcautious? Is there evidence for a correct answer to the above problem? What are peoples views? Dr Simon Bell SpR A+E Medicine University Hospital Lewisham. __________________________________________________ Do You Yahoo!? Talk to your friends online with Yahoo! Messenger. http://im.yahoo.com %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%