STEMI-Contra Indication of Thrombolytic therapy - USMLE Forums
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Old 06-19-2011
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Heart STEMI-Contra Indication of Thrombolytic therapy

The following indicates an absolute contraindication to thrombolytic therapy in Acute ST segment elevation MI...Choose one:

a) 70year old hypertensive male with acute chest pain and new diastolic murmur in the left lower sternum and ST elevation in lead II,III and aVF
b) 40 year old lady with 7 missed periods and abdominal distension
c) 34 old diabetic male recently underwent "LASER Retinal therapy " as he said ..came with shock ,raised JVP and clear lungs.
d) ST elevation in lead V1,V2,V3 with a blood pressure of 180/100 easily controlled with antihypertensive medications
e) 60 year old male who is a known case of ischemic heart disease presents with new LBBB and chest pain for 2 hours with ST elevation in V4, V5, and V6
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Old 06-19-2011
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iwll go with c (recent surgery )

about D is also CI HT>180/110 but it is easy controlled
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Old 06-20-2011
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yes its recent surgery so c
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Old 06-20-2011
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It looks like not so many people are interested or that the question is too tricky
However, the answer is simple to find.
I will give more couple of hours before giving the right answer and explanation
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Old 06-20-2011
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Default correct answer

Correct Answer (Choice A)
the patient has suspected Aortic Disection

Choice B: No specific precautions should be taken
Choice C: and D are relative contraindications: Minor surgery, Controlable HTN
Choice E: Actually the patient is indicated for rapid thrombolysis


Contra indications to Thrombolytics:

Absolute
Previous intracranial bleeding at any time, stroke in less than 3months,closed head or facial trauma within 3 months,suspected aortic dissection ,ischemic stroke within 3 months(except in ischemic stroke within 3hours time), active bleeding diathesis, uncontrolled high blood pressure (>180 systolic or >100 diastolic),known structural cerebral vascular lesion.

Relative
Current anticoagulant use, invasive or surgical procedure in the last 2 weeks, prolonged cardiopulmonary resuscitation (CPR) defined as more than 10 minutes, known bleeding diathesis, pregnancy, hemorrhagic or diabetic retinopathies, active peptic ulcer, controlled severe hypertension
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Old 06-20-2011
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Any one consider B.as a pregnant woman?

Pregnancy is a relative contraindication to thrombolysis!
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Quote:
Originally Posted by 1TA2B View Post
Any one consider B.as a pregnant woman?

Pregnancy is a relative contraindication to thrombolysis!

preg is relative contraindication....quest is asking absolute so ans is a....i thought surg to be absolute...moreover it says recent surg not mentioning days so i think its A
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