Twists and Turns in The Fibrinolytic Therapy of Infero-Posterior ST Elevation Myocardial Infarction and Right Ventricular Infarction Patient with Cardiogenic Shock: A Case Report
Bibliographic record
Abstract
Introduction: Fibrinolytic therapy is preferred for ST-segment elevation myocardial infarction (STEMI) when the timeframe for percutaneous coronary intervention (PCI) cannot be achieved. Although effective, fibrinolytics are also associated with several adverse effects in addition to the complications of STEMI itself. Case: A 45-year-old active smoker man presented with chest pain, dyspnea, and diaphoresis for the past hour. Electrocardiography revealed infero-posterior STEMI with right ventricular infarction. Echocardiography demonstrated akinetic inferior, infero-septal, and posterior walls with an estimated right atrial pressure of 15 mmHg. Management: Therapy consisted of aspirin, clopidogrel, furosemide, and streptokinase infusion. Within five minutes of initiating streptokinase, the patient developed sudden hypotension that required norepinephrine, dobutamine, and dopamine. At approximately halfway of the streptokinase infusion, he developed accelerated idioventricular rhythm which progressed to pulseless ventricular tachycardia lasting for one minute. Before defibrillation was performed, his rhythm reverted to sinus, after which a bolus of amiodarone was administered. Given his instability, streptokinase was discontinued after approximately 70 percent of the total dose had been delivered. Outcome: The patient was transferred to the intensive care unit with stable hemodynamic, resolved chest pain, and more than 50 percent ST-segment resolution on ECG. Heparin, atorvastatin, maintenance amiodarone, and furosemide were added to his regimen. He continued to improve clinically and was discharged without complication. Conclusion: This case shows that fibrinolysis remains essential when PCI is unavailable, but streptokinase can cause hemodynamic and arrhythmic complications, highlighting the need for close monitoring and rapid intervention in resource-limited settings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".