We know all that De Winter ECG pattern is equal proximal LAD occlusion. would you go for lytic therapy in case of typical chest pain?
Hi Mustafa,, very interesting question. Normally thrombolytic therapy is given in ST elevation cases of acute MI. De winter sign in ECG is upslopping ST depression in precordial leads and tall T waves with mild ST elevation in aVR and is suggestive of acute proximal LAD occlusion. Ideally early PCI is the treatment of choice. If PCI facilities are not available then probably thrombolytic therapy might help... Following link might help you.. Thanks
I totally agree with Dr Biswajit in his reply. Thrombolytic therapy is indicated when the option of PCI is not available
Thrombolytic agent is not to be given because different mechanism of this condition ,PCI is the treatment of choice , if not available the conservative treatment followed by referral for PCI
Hi Ajay,, definitely PCI is the treatment of choice. But in many countries including India where PCI capable centre are not available in nearby,then thrombolytic can be given if symptoms does not improve and there is less chance of bleeding following link might help you .. Thanks
It is true that De Winter sign in ECG is very suggestive of ACS related to proximal LAD occlùsion. But I don't think it is sufficiently specific to justify thrombolytic therapy. Certainly, coronary angiogram and intervention are indicated at the earliest. One should ordinarily refrain from thrombolytic therapy in ACS cases without ST segment elevation. Inadvertent thrombolysis also carries approximately 0.7% to 1% risk of intracraniaĺ haemorrhage or other major bleed. In a setting where interventional facility is not available, serial ECGs may help. Many patients with De Winter sign initially can later develop ST elevation and then decision to thrombolysis becomes easy. If facility for echocardiography is available, that may also be utilised to look for wall motion or wall thickening/ strain rate abnormalities in the LAD territory. Point of Care high sensitivity Troponins may also help.
Inadvertent thrombolysis leading to major bleed can also have legal implications.
I will consider thrombolytic therapy if the chance of getting a PCI within two hours is low. However, PCI is the goal standard like it has been highlighted.
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