ABC: časopis urgentne medicine (Jan 2014)
Acute coronary syndrome with ST elevation (STEMI): Prehospital trombolitic therapy
Abstract
INTRODUCTION: Acute coronary syndrome(ACS) refers to any group of symptoms attributed to obstruction of the coronary arteries. The most common symptom prompting diagnosis of ACS is chest pain, often radiating of the left arm or angle of the jaw, pressure-like in character, and associated with nausea and sweating. Acute coronary syndrome usually occurs as a result of one of three problems: ST elevation myocardial infarction (30%), non ST elevation myocardial infarction (25%) or unstable angina (38%). Metalyse is indicated for the thrombolytical treatment of suspected myocardial infarction with persistent ST elevation or recent left bundle branch block within 6 hours after the onset of acute myocardial infarction symptoms. The amount of salvageable heart tissue is inversely related to the duration of coronary artery occlusion, up to 6 hours after the first symptoms of acute myocardial infarction (AMI), when myocardial ischemia becomes irreversible. CASE REPORT: This is a case report about a 55 years old man who had a myocardial infarction and was treated with tromboliytic therapy in the prehospital setting by the emergency service. The patient rode a bicycle in the morning for about 10 km. While riding he felt chest pain, filling shortness of breath. Passerby called Emergency services at 6:24 am. In the emergency car ECG was done which showed a ST segment elevation from V1 to V6 . Arterial pressure was 160/90mmHg, hart frequency 70/min, SpO2 96%, GCS 15.In the car was administered therapy: Zofran 4mg, Aspirin 500 IV. Heparin 10.000 IJ, Vendal 10mg, and in 6:52Metalyse amp. 10.000 IJ/10ml : 6000/1KG 55kg. Ringerlactate 500 ml IV. When patient arrived in Emergency department, laboratory analisys and heartultrasonography weremade. Heart ultrasonography was showed akinesia of the septum and anterior heart wall size of left ventricul 3.19 cm. Within 120 minutes primary coronary angiography was made, which showed proximal LAD stenosis 70% - 90% TIMI III , a implatation STENT. CONCLUSION: Prehospital thrombolysis in acute coronary syndrome with ST-segment elevation is very important for patient survival and reduce complications after ACS.
