Complications
Recurrent ischaemia or failure to reperfuse (usually detected as persisting pain and ST-segment elevation in the immediate aftermath of thrombolysis): analgesia, GTN, B-blocker, consider re-thrombolysis or angioplasty.
Stroke.
Pericarditis: analgesics, try to avoid NSAIDs.
Cardiogenic shock: and heart failure:
Thrombolysis
effective in reducing mortality if given early. Greatest benefit is seen if given <12h of the onset of chest pain, but some benefit up to 24h. The British Heart Foundation advises that the time from onset of pain to thrombolysis should be <90min (<60min if possible).
Indications for thrombolysis:
Presentation within 12h of chest pain with:
ST elevation >2mm in 2 or more chest leads or
ST elevation >1mm in 2 or more limb leads or
Posterior infarction (dominant R waves and ST depression in V1-V3)
New onset left bundle branch block.
Presentation within 12-24h if continuing chest pain and/or ST elevation.
Thrombolysis contraindications: (consider urgent angioplasty instead)
Internal bleeding
Prolonged or traumatic CPR
Heavy vaginal bleeding
Acute pancreatitis
Active lung disease with cavitation
Recent trauma or surgery (<2wks)
Cerebral neoplasm
Severe hypertension (>200/120mmHg)
Suspected aortic dissection
Previous allergic reaction
Pregnancy or <18wks postnatal
Severe liver disease
Oesophageal varices
Recent head trauma
Recent haemorrhagic stroke
Relative CI:
History of severe hypertension; peptic ulcer; history of CVA; bleeding diathesis; pregnancy; 18 weeks post-partum; anticoagulants.
