Abstract
Prompt and appropriate administration of thrombolytic therapy is important for patients with acute myocardial infarction. However, in addition to contraindications, alternative causes of ST‐segment elevation should be considered before thrombolytic therapy is instituted. A patient with marked ST‐segment elevation in the anterior leads suggestive of acute ischemia is presented. Because of lack of ischemic symptoms, an echocardiogram was performed. This showed mild generalized hypokinesis, and thrombolytic therapy was not administered. Subsequent ECGs demonstrated evolutionary findings consistent with pericarditis. In selected patients a two‐dimensional echocardiogram, which can be easily performed at patient bedside, will help in appropriate patient management.
Keywords: electrocardiogram, myocardial infarction, pericarditis, echocardiogram
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References
- 1. GISSI (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto miocardico) International Study Group : Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986; 1: 397–402. [PubMed] [Google Scholar]
- 2. ISIS‐2 (Second International Study of Infarct Survival) Collaborative Group : Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS‐2. Lancet 1988; 2: 349–360. [PubMed] [Google Scholar]
- 3. The GUSTO (Global Utilization of Streptokinase and t‐PA for Occluded Arteries) Investigators : An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993; 329: 673–682. [DOI] [PubMed] [Google Scholar]
- 4. Levine HJ: Difficult problems in diagnosis of chest pain. Am Heart J 1980; 100: 108–118. [DOI] [PubMed] [Google Scholar]
- 5. Walsh RA, O'Rourke RA: Chest pain In Internal Medicine, 3rd ed., (Ed. Stein JH.), p. 60–64. Boston: Little Brown & Co., 1990. [Google Scholar]
- 6. Barnes AR, Burchell HC: Acute pericarditis simulating myocardial infarction. Am Heart J 1942; 23: 247–268. [Google Scholar]
- 7. Spodick DH: Pitfalls of recognition of pericarditis In Clinical Essays on the Heart, Vol. 5 (Ed. Hurst JW.). New York: McGraw‐Hill Book Co., 1985. [Google Scholar]