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A 62 year old woman admitted with a history suggesting acute myocardial infarction had thrombolytic treatment with anisoylated plasminogen-streptokinase activator complex, which resulted in submucosal haemorrhage in the oesophagus; this caused dissection of the wall of the oesophagus and complete dysphagia. The haematoma resolved spontaneously, leaving behind a diverticulum, with reduced peristalsis and delayed emptying but no obstruction. (Thorax 1992;47:835-836) Thrombolytic treatment is now an established part of treatment for acute myocardial infarction. Serious haemorrhagic sequelae, though rare, are a recognised complication of thrombolytic treatment. We describe a case of submucosal haemorrhage in the oesophagus that followed treatment with anisoylated plasminogen-streptokinase activator complex.

Medical audit in a district general hospital coronary care unit led to the introduction of an emergency cardiac enzyme service. 91.2% of patients eligible for thrombolysis therapy received treatment following this introduction compared to 73.7% before (P=.05). No patient was treated inappropriately on the basis of a raised cardiac enzyme.

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