Early deaths with thrombolytic therapy for acute myocardial infarction in corticosteroid‐dependent rheumatoid arthritis
| Autor: | M J McGreevy, A Kotha, M Look, M H Weisman, P Kotha |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Heart disease Short Communications Anti-Inflammatory Agents Myocardial Infarction Arthritis Myocardial rupture Sudden death Arthritis Rheumatoid Fatal Outcome Internal medicine medicine Humans Thrombolytic Therapy Myocardial infarction cardiovascular diseases Aged business.industry Standard treatment General Medicine Middle Aged medicine.disease Surgery Death Sudden Cardiac Rheumatoid arthritis Cardiology Myocardial infarction complications Prednisone Female Cardiology and Cardiovascular Medicine business |
| Popis: | Intravenous thrombolytic therapy has become standard treatment for acute myocardial infarction (AMI). We describe three patients with long-standing seropositive rheumatoid arthritis (RA) on chronic corticosteroid therapy who experienced very early (1-6 h) mortality after the use of intravenous thrombolytic therapy for the treatment of AMI. All three patients likely experienced electromechanical dissociation (EMD). Their charts were evaluated in depth, and the literature was reviewed in regard to possible etiopathologic mechanisms. Within 1-6 h of apparently successful thrombolytic therapy for AMI, these three patients experienced sudden and profound bradycardia and hypotension and could not be resuscitated. The potential occurrence of EMD in all three patients raises the possibility of accelerated myocardial rupture, as EMD is one of the clinical hallmarks of this condition. As suggested by the three clustered cases, this heretofore undescribed association between sudden unexpected cardiac death and thrombolytic therapy for AMI in patients with seropositive, corticosteroid-dependent RA suggests that further study and observation are needed. This deleterious association, if verified, has important implications for the treatment of AMI in patients who have RA and are corticosteroid dependent. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|