An elderly female presents to the emergency depament and was found to have a transmural myocardial infarction. Based on her ECG, she was staed on thrombolytie therapy with streptokinase. On fuher examination, which of the following findings would indicate that the thrombolytic therapy is risky and should be stopped
Ans. c. Significant pericardial effusion on echocardiography Fibrinolytics and anticoagulants can be continued in case of pericarditis, however, once significant pericardial effusion develops after MI, fibrinolytics should be discontinued "The risk of post MI pericardial effusion is not increased with the use of fibrinolytic agents, heparin, aspirin and other antiplatelet agents. In contrast, a pericardial effusion occurring I the setting of MI is an indication to discontinue anticoagulation and fibrinolytics. Fibrinolytic Therapy Absolute Contraindications History of cerebrovascular hemorrhage at any timeQ A non-hemorrhagic stroke or other cerebrovascular event within the past yearQ Marked hypeension (areliabl determined systolic aerial pressure >a180 mm Hg and/or a diastolic pressure>110 mm Hg) at any time during theacute presentation, suspicion of aoicdissection, and active internalbleeding (excluding menses).Q Relative Contraindications Current use of anticoagulantsQ(INR 2) A recent (<2 weeks) invasive or surgical procedure or prolonged (> cardiopulmonary resuscitation)Q Known bleeding diathesisQ PregnancyQ A hemorrhagic ophthalmic condition (e.g., hemorrhagic diabetic retinopathy) ctive peptic ulcer diseaseQ A history of severe hypeension that is currently adequatelyQ Allergic reactions to streptokinaseQ
Pericardial friction rub
Mobitz Type II block
Significant pericardial effusion on echocardiography
Lower limb vein thrombosis