Clinical pitfalls in the non-invasive thrombolytic approach to presumed acute myocardial infarction.

A 32 year old patient who presented with a clinical and electrocardiographic picture consistent with an acute inferior myocardial infarction was treated with intravenous streptokinase without the aid of acute angiographic study. Subsequent evaluation revealed the initial diagnosis of acute infarction to be incorrect and the patient was found to have acute viral myopericarditis. No adverse sequelae resulted from the administration of the thrombolytic agent. The potential and reported adverse effects of a non-invasive thrombolytic approach to presumed acute infarction are reviewed and considerations related to clinical decision making in this setting are discussed.