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Three Part Question

In [ patients with right ventricular MI, based on the use of accessory chest leads] is [ thrombolysis better than nothing ] at [ reducing mortality and/or morbidity]

Clinical Scenario

A 62 year old male attends the department with central crushing chest pain, sweating and shortness of breath he has vomited twice.His chest is clear, he is hypotensive and has a raised JVP. ECG reveals bradycardia and ST elevation in aVR. Clinically convinced he has a right ventricular infarct you repeat the ECG using right sided chest leads which show ST elevation of 2mm in three leads. Happy that this man has an isolated right sided infarct you wonder whether there is any evidence supporting your plan to thrombolyse.

Search Strategy

Medline 1966-10/02 and EMBASE 1980-10/02 using the OVID interface
Medline 1966 to 9/01 and EMBASE 1980 to 9/01 using the OVID interface [{exp Myocardial infarction OR (myocard$ adj5 infarct$).af OR (heart attack).af} AND {exp Fibrinolysis/ OR exp Thrombolytic Therapy/ OR exp Fibrinolytic Agents/ OR exp Tissue Plasminogen Activator/ OR exp Streptokinase/ OR exp Urinary Plasminogen Activator/ OR thromboly$.af. OR fibrinoly$.af OR streptokinase.af OR urokinase.af OR alteplase.af OR APSAC.af OR reteplase.af OR (plasminogen adj5 activator).af} AND {right.af}]LIMIT to human and English Language

Search Outcome

277 papers found on Medline, 354 on EMBASE none answer the three part question.

Comment(s)

All studies performed so far on thrombolysis in right ventricular MI have been based on clinical or accessory lead findings in patients with extension of inferior AMI. Some may have also been thrombolysed in studies where ST depression was used as criteria for thrombolysis however this may be reciprocal changes (shown to have higher mortality) or purely ischaemia. Further trials of thrombolysis are required using accessory leads.

Clinical Bottom Line

There is currently no evidence to confirm or refute the use of thrombolysis in isolated right ventricular MI with no reciprocal changes.