BMJ 1994;308:1159-1160 (30 April)

Letters

Confirm diagnosis before giving thrombolytic treatment

EDITOR,--The British Heart Foundation has produced guidelines for the early management of patients with acute myocardial infarction, emphasising the importance of reducing the "call to needle time."1 We agree with these recommendations, but believe that the diagnosis of acute myocardial infarction should be as certain as possible before thrombolysis can be given safely. We report an unusual complication after thrombolysis was given to a patient in whom the diagnosis was wrong.

A 34 year old man was transferred from a district hospital to our invasive care unit because of haemodynamic instability after thrombolytic treatment for acute myocardial infarction.

Acute myocardial infarction had been diagnosed on the basis of 1 mm horizontal elevation of the ST segment in leads II and III and AVF and decreased pain after sublingual nitrates.

On arrival in the intensive care unit the patient was complaining of epigastric and left upper abdominal pain that radiated to . . . [Full text of this article]


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