FIGURE 2.13. Accelerated idioventricular rhythms.
(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emergency
Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:189.)
TABLE 2.7. Contraindications to Fibrinolytic Therapy in Acute Myocardial Infarction
Absolute contraindications
Previous hemorrhagic stroke at any time
Bland CVA in past year
Known intracranial neoplasm
Active internal bleeding (excluding menses)
Suspected aortic dissection or pericarditis
Relative contraindications
Severe uncontrolled blood pressure (> 180/100 mmHg)
History of chronic severe hypertension
History of prior CVA or known intracranial pathology not covered in contraindications
Current use of anticoagulants with known INR > 2–3
Known bleeding diathesis
Recent trauma (past 2 wk)
Prolonged CPR (>10 min)
Major surgery (<3 wk)
Noncompressible vascular punctures (including subclavian and internal jugular central lines)
Recent internal bleeding (2–4 wk)
Prior streptokinase (should not receive streptokinase)
Pregnancy
Active peptic ulcer disease
Other medical conditions likely to increase risk of bleeding(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emergency Medicine:
A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:353.)
CARDIOVASCULAR EMERGENCIESCOMPLICATIONS
Divided into early and late complications (see Table 2.9)
SPECIALGROUPS INACUTECORONARYSYNDROME(ACS)
Women
■ Prolonged atypical prodromal symptoms: fatigue, shortness of breath,
anxiety, ingestion
■ Delay in seeking care
■ Physicians tend to minimize their symptoms.