P139 RETURN TO THE ORIGINS: WHEN THE THROMBOLYSIS SAVES THE ANGIOPLASTY

Abstract A 62 year old man arrived in PS for typical chest pain radiating to the jugular and associated with sweating about three hours. History of arterial hypertension untreated dyslipidemia, family history CVD. ECG: sinus rithm at rate 50 bpm first degree AVB. Inferior ST elevation inferior leads depression V2–V3. Echocardiogram: depressed systolic function (EF 48%) relation hypo–akinesia mid–basal segments inferior–posterior–lateral wall. Diagnosed STEMI inferior–posterior, was sent cath lab undergo emergency coronary angiography, findings non–significant atheromas on IVA Cx. Multiple unsuccessful attempts search right artery failure visualize aortography two complementary projections. During procedure hemodynamic electrical instability, worsening angor, marked hypotension extreme bradycardia up complete AVB asystole phases. Inotropics atropine were started, which proved ineffective, it therefore decided proceed implantation a temporary pacemaker. placement, patient presented cardiac arrest from VF (likely an irritating effect passage lead through tricuspid) treated effective DC–shock. Given technical difficulties proceeding mechanical revascularization given patient‘s decision made postpone PCI by attempting systemic thrombolysis. Early efficacy thrombolysis disappearance precordial pain, improvement echo motion reduction > 50% ST–segment rare spontaneous QRS displayed transient shutdown PM. Subsequent emergence AF 116 bpm. Approximately 12 hours after thrombolysis: resolution absence Q waves. AngioTC coronaries performed showed regularl origin Cdx but higher lateralized left, severe lesion segment. So underwent falicitated detection ostio–proximal thrombotic effectively PTCA drug–eluting stent placement good final angiographic result. Control echo: preserved global left ventricular (FE 55%), hypokinesia basal segment The remaining stay decurred without any complications discharged indications close follow–up.