Tödlicher Verlauf einer prähospitalen Thrombolyse einer einen ST-Streckenhebungsinfarkt vortäuschenden Aortendissektion

摘要

A 61-year old female patient was seen by the emergency doctor with severe chest pain, beginning cardiogenic shock, marked concave ST segment elevation in anteroseptal leads and reciprocating ST depression in leads I, II, V₅ and V₆. After a control recording showed identical electrocardiographic abnormalities, an acute anterior myocardial infarction was diagnosed. While still in her residence, a prehospital thrombolysis with tenecteplase was initiated. During the transport to hospital, the patient rapidly lost consciousness. The signs of cardiogenic shock increased dramatically, and newly diagnosed anisocoria was noted. Under cardiopulmonary resuscitation, the patient was delivered to the coronary care unit. An intracerebral hemorrhage due to preshospital thrombolysis was suspected. However, the echocardiographic examination showed a large pericardial effusion. All measures of resuscitation remained unsuccessful. The autopsy revealed a dissection of the aorta with hemopericardium which had mimicked ST elevation myocardial infarction. The fatal outcome of thrombolytic therapy initiated erroneously in aortic dissection mimicking ST elevation myocardial infarction is a rare, but well-known complication in hospital thrombolysis. To our knowledge, this is the first report of this complication after prehospital thrombolysis.