Key result
Tenecteplase thrombolysis proves lethal in a case of inferior STEMI mimicking type A aortic dissection.
Case Report (n=1)
Highlights the critical importance of early transthoracic echocardiography to rule out aortic dissection before administering thrombolysis in patients presenting with STEMI.
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Fatal thrombolysis in dissection-mimic STEMI warrants imaging caution before lysis; leaves open prospective validation of early echocardiography protocols.
Thrombolysis, a standard therapy for ST elevation myocardial infarction (STEMI) in non-PCI-capable hospitals, may be catastrophic for patients with aortic dissection leading to further expansion, rupture and uncontrolled bleeding. Stanford type A aortic dissection, rarely may mimic myocardial infarction. We report a case of a patient with an inferior STEMI thrombolysed with tenecteplase and followed by clinical and electrocardiographic evidence of successful reperfusion, which was found later to be a lethal acute aortic dissection. Prognostic implications of early diagnosis applying transthoracic echocardiography (TTE) are described.
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Tsigkas et al. (2011) conducted a case report in Inferior STEMI / Stanford type A aortic dissection (n=1). Tenecteplase was evaluated. Thrombolysis with tenecteplase in a patient with an inferior STEMI mimicking a Stanford type A aortic dissection resulted in lethal consequences, highlighting the need for early echocardiography.
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