Do we need echocardiography before commencing thrombolytic therapy?

• Published in: The American journal of emergency medicine Vol. 29; no. 2; pp. 240.e1 - 240.e3
• Main Authors: Hasanin, Adel M., MD, Kinsara, Abdulhalim J., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2011; Elsevier Limited
• Subjects: Adult; Blood clots; Blood pressure; Brain; Cardiomyopathies - diagnostic imaging; Cerebral Infarction - complications; Cerebral Infarction - etiology; Contraindications; Drug therapy; Echocardiography; Emergency; Emergency medical care; Fatal Outcome; Heart attacks; Heart failure; Hemorrhage; Humans; Infarction; Kidney - blood supply; Male; Medical imaging; Mortality; Myocardial infarction; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - therapy; Risk Assessment - methods; Risk factors; Studies; Substance abuse treatment; Thromboembolism - diagnostic imaging; Thromboembolism - etiology; Thrombolytic Therapy - adverse effects; Veins & arteries; Ventricular Dysfunction, Left - diagnostic imaging
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2010.02.017

Abstract We report a case of a 41-year-old man who had fatal multiple cerebral and bilateral renal infarcts 1 hour after initiation of thrombolytic therapy for acute ST elevation myocardial infarction. Echocardiography study disclosed dilated left ventricle with severe global hypokinesia suggestive of preexisting cardiomyopathy and a disintegrated left ventricular apical thrombus pointing out to the source of the embolic complication. This raises the question whether echocardiography before initiating thrombolytic therapy would affect the decision of commencing thrombolytic therapy and help avoiding such lethal embolic complications.