Early deaths with thrombolytic therapy for acute myocardial infarction in corticosteroid‐dependent rheumatoid arthritis

Abstract

Summary:Intravenous thronibolytic therapy has become stantlard treatment for acute myocardial infarction (AMI). We describe three patients with long-standing seropositive rheumatoid arthritis (RA) on chronic corticosteroid therapy who experienced very early ( I 4 h) mortality after the use of inlravenous thrombolytic therapy for the treatment of AMI. All three patients likely experienced electromechanical dissociation (EMD). Their charts were evnluated in depth, and thc literature was reviewed in regard to possible etiopathologic mechanisms. Within 1-6 h of apparently successful thrombolytic therapy for AMI, these three patients experienced sudden and profound bradycardia and hypotension and could not be resuscitated. The potential occunence of EM I1 in all three patients raises the possibility of accelerated myocardial rupture, as EMD is one ofthe clinical hallmarks of this condition. As suggested by the three clustered cases. this heretofore undescribed association between sudden unexpected cardiac death and thrombolytic therapy for AM1 in patients with seropositive, corticosteroid-dependent RA suggests that further study and observation are needed. This deleterious association, if verified. has important implications for the treatment of AM1 i n patients who have RA and arc corticosteroid dependent.

Is Acute Coronary Syndrome Secondary to Coronary Vasculitis Underestimated in Daily Cardiology Practice?

“…Because the treatment modalities are quite different in approach to MI based on the underlying mechanism. We suppose that if elevated CRP/ ESR be due to inflammatory process within the vessel wall, then a classic approach of anticoagulants, thrombolytic therapy or primary coronary angioplasty paradoxically could be dangerous [13] and, vice versa, different look with using glucocorticoids could be lifesaving, the medication that later on proved that can improve prognosis in ACS and MI [14,15] .…”