First Two Cases of Trombolytic in RSUD Bangkinang, Failed or Success ?

Alfath Rahmat1, Alimora1 ; Putri Yeantesa2

1
General Practitioner in RSUD Bangkinang, Kampar, Riau, Indonesia;
2
Cardiologist in RSUD Bangkinang, Kampar, Riau, Indonesia

Background

ST Elevation Myocard Infarction (STEMI) is total blockage of coronary artery that needs to immediate
revascularization to reduce morbidity and mortality of patient.

Case Description

First case

A 56 years old man came with 4 hours onset of typical infarc chest pain, stable haemodinamic. His
Electrocardiography (ECG) showed Sinus Bradycardia with ST Elevation in lead II, III, and aVF and ST
depression in I, aVL, V1-V3. Bloodglucose 275 mg/dl. Trombolytic conducted in 5 hours onset.
Haemodinamic is stable along of Trombolytic, Pain Scale is 0/10, no arrhytmia. Next day, ECG showed q
pathologic in III, aVF with isoelectric ST-segmen. On 3 rd day, patient asked to discharged and we
suggested to PCI.

Second case

A 57 years old man came with 5 hours onset of typical infarc chest pain, bloodpressure was 169/
89mmHg. ECG showed ST-segments Elevation in V1-V4. Bloodglucose 522 mg/dl. Trombolytic
conducted in 6 hours onset, stable haemodinamic along of Trombolytic, pain relief and no changes ECG
after Trombolytic, but patient still tachycardia 120x/minutes. Patient refused to PCI. On 5 th day, ECG
predischarged showed Evolution, no q pathologic and T bifasic in anterior segment.

Discussion

Criteria of Successful Trombolytic is disappearance of chest pain, ST-segment resolution >50% at 60-
90minutes, typical reperfusion arrhytmia, and early and higher peak of cardiac troponin I within the first
24hours after onset.

First case, Success but q Pathologic. Was a reinfarction?

Second case, Failed with Persistent ST-Elevation. Was it continuing ischemia?

Conclusion

Keyword

Chest Pain, ST-Elevation Myocard Iinfarction, Electrocardiography, Reperfusion, Fibrinolytic.