Caso 3: Mulher idosa com infarto agudo do miocárdio apresentou choque súbito durante administração de trombolítico

Abstract

The laboratory assessment disclosed levels of urea: e68 mg/dl, creatinine: 1.2 mg/dl, glycemia: 189 mg/dl and creatine kinase: 42 U/l. A diagnosis of ongoing myocardial infarction was achieved and TNK-tPA (Tecneplase -a genetically modified form of t-PA, with increased PAI-1 resistance, increased fibrin specificity and longer half-life) ficiwas administered as bolus of 40 mg with non-fractionated heparin as bolus of 6,060 UI/kg, followed by 1,000 UI/h IV. A residual retrosternal pain persisted.One hour after the start of the treatment, the patient presented right hypochondrial pain, followed by cardiogenic shock. Volume replacement and dopamine were administered. The control electrocardiogram (April 7, 2001, 2: 17 PM) showed sinus tachycardia, HR of 110 bpm, QS complexes with ST-segment elevation in uI, III, aVF, and from V 1 to V 6 ( Figure 3). A rescue angioplasty was indicated. However, the patient presented cardiac arrest with pulseless electrical activity, did not respond to the resuscitation maneuvers and died. Clinical aspectsIn a case such as the one described here, of a 72-yearold female patient, with history of coronary artery disease and myocardial revascularization carried out more than 10 years before, who sought emergency medical assistance due to typical precordial pain, the initial evaluation must always include an electrocardiogram (ECG). A normal ECG or an ECG with non-specific alterations or signs of ischemia would lead to an initial approach that would be different from the one described here. The admission ECG of this patient showed ST-segment elevation.Considering that the patient had been submitted to a previous myocardial revascularization (MR), the correlation of the diagnostic findings of the ECG deserves special attention. First, the presence of chronic coronary artery disease, as well as the previous MR without the appropriate description of the grafts used in the surgery makes it difficult to establish the electrocardiographic correlation with the culprit artery, due both to the presence of bypasses and the possible existence of an extensive collateral network. It is also important to remember that, in spite of the native artery lesions, the probability of lesions in bypasses is of 38% 1 . Additionally, the history of chronic coronary disease in elderly diabetic women and the QS in the anterior wall raises the possibility of previous myocardial infarction in the anterior wall, and, as a consequence, the possible correlation of the ST-segment elevation corresponding with the presence of aneurysm in the same wall. Still, the existence of ST-segment elevation in A 72-year-old female patient sought medical assistance due to precordial pain that had lasted for two hours.

Características clínicas e a prevalência de angina em pacientes coronarianos atendidos em ambulatórios de cardiologia no município de Cascavel, Paraná

“…Após essa introdução da anatomia, é possível correlacionar os efeitos fisiológicos com os resultados de exames, como o eletrocardiograma, de acordo com a artéria que foi acometida (Bittencourt et al, 2010).…”