Inferior infarction, evolution after fibrinolysis

Patient

51-year-old man, smoker, hypertensive, hospitalized in a peripheral hospital for typical constrictive chest pain, unresponsive to sublingual nitroglycerine initiated 4 hours earlier;

Trace

Sinus rhythm, normal PR interval; presence of Q-wave in the inferior territory with ST-segment elevation and positive T-wave suggestive of an acute inferior myocardial infarction; reciprocal high amplitude depression in leads I, aVL, V2;

Trace

Tracing recorded simultaneously with the right and posterior leads; absence of elevation in these additional leads; inferior infarction without right ventricular extension or to the posterobasal aspect of the left ventricle;

Trace

The hospital center does not have emergency angioplasty services and is 2 hours away from the first available coronary angiography unit; fibrinolysis is thus performed; tracing recorded 15 minutes after the initiation of fibrinolysis; slight decrease in the amplitude of the elevation and of the reciprocal depression;

Trace

Tracing recorded 30 minutes after the initiation of fibrinolysis; resolution of pain and evidence of ventricular couplets (alternans between a ventricular complex of sinus origin and a ventricular extrasystole);

Trace

Tracing recorded at the end of fibrinolysis; complete regression of the elevation with the appearance of a negative T-wave in leads III and aVF;

Trace

Tracing recorded two days after; sinus bradycardia with negative, wide, symmetrical T-waves in the inferior territory with deep Q-waves; negative T-waves from V4 to V6;

Exergue

Following fibrinolytic therapy, various clinical and electrocardiographic signs are suggestive of an effective reperfusion: rapid resolution of anginal symptomatology, regression of the elevation, occurrence of reperfusion arrhythmias, early appearance of a negative T-wave.