Meléndez H R, Leiva Pons J L, Simón S, Céspedes F, Peña Duque M A
Departamento de Urgencias, INCICH.
Arch Inst Cardiol Mex. 1996 Mar-Apr;66(2):122-8.
Myocardial infarctions which are derived from embolic source have an incidence of 5-13%. They are at risk of systemic embolism. The pathogenesis of myocardial infarction is similar to that of those myocardial infarction whose etiology is atherosclerosis. This make it susceptible to thrombolysis. We report 3 patients with either inactive rheumatic heart disease, coarctation of the aorta or mechanical valvular prosthesis as the probable causes of an embolic infarction. It was located in the posterior-inferior region with a dorsal extension. These patients were treated with intravenous streptokinase. The three of them fulfilled criteria for myocardial reperfusion. Two of them suffered post-infarction angina. In the first case reocclusion of the righ coronary artery was observed; thus a saphenous vein graft was undertaken. In the second, the persistence of thrombus required three month treatment with anticoagulants. The third patient showed not coronary lesions. In conclusion, thrombolytic therapy with streptokinase in acute infarction of embolic origin prevents the progression of ischemic damage and betters the clinical outcome of the patient. Furthermore such disease should be suspected in patients that have risk factors for systemic embolism and normal coronary arteries and with obstruction of a single vessel.
