The Good News and the Bad News

Report:

Sinus rhythm.

LVH voltage.

Comment:

The bad news is that the patient was thought to have acute myocardial infarction and was given routine streptokinase infusion, resulting in a hæmorrhagic stroke. He was transferred to WVH later for rehabilitation. [!xe "Streptokinase:causing CVA" \i!]

The good news is that he did not require streptokinase in the first place! I often wondered what he or his family were told.

The prominent T waves associated with some ST segment elevation were obviously mistaken for hyperacute pattern of anterior infarction. Note, however, that only one complex is seen in V5 and that the expected reciprocal changes are absent.[!xe "T wave:normal, mistaken for MI" \i!]

If in doubt, don't.

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