Case report: reversal of an evolving myocardial infarction with intravenous thrombolysis

Abstract

This case, in many ways, represents the ideal: a timely and effective administration of thrombolytic agents. The rarity of this situation reinforces the need for earlier recognition and treatment of infarction. In an analysis of time delays in thrombolytic therapy, 38% were attributed to in-hospital issues, 22% to patients' delays, 21% to problems with transportation, and 19% to reperfusion time. The National Heart Attack Alert Program calls for treatment within 1 hour of the development of signs and symptoms, including administration of thrombolytic agents within 30 minutes of the patient's arrival in the emergency department. That program seeks heightened awareness among hospital and prehospital providers and public education about seeking immediate treatment for chest pain. The prompt acquisition of additional ECGs and the subsequent rapid administration of a thrombolytic agent were the clinical essentials. This fact suggests the need to look for measures of quality other than simple "door to drug" times. "Data to drug" times may be another indicator of quality to address cases in which the initial ECG findings are not diagnostic. Furthermore, emergency departments may see more patients with impending infarction if public education campaigns are successful. This case emphasizes the need to obtain follow-up ECGs in light of the potential benefits from thrombolysis.