Which criteria indicate it is appropriate to use fibrinolytics in a patient with acute MI?

Which criteria indicate it is appropriate to use fibrinolytics in a patient with acute MI?

• A. Symptom onset within the previous 12 hours, STEMI
• B. Onset within 24 hours with NSTEMI
• C. ST segment improvement with therapy
• D. Chest pain with normal ECG

Answer: (A)

In acute myocardial infarction, fibrinolytics are used when there is a STEMI because a fully occluded coronary artery needs rapid clot dissolution to restore blood flow and limit heart muscle damage. The benefit is greatest in the first hours after symptoms begin, so a patient presenting within about 12 hours with ST-segment elevation on ECG is the scenario where fibrinolysis is appropriate, especially if primary PCI isn’t available promptly. In NSTEMI, the artery is usually not completely occluded, so fibrinolytics are not the standard therapy. A chest pain patient with a normal ECG wouldn’t have STEMI, so fibrinolysis wouldn’t be indicated. If ST segments improve after therapy, that suggests reperfusion has occurred, which changes management away from ongoing lysis.

In acute myocardial infarction, fibrinolytics are used when there is a STEMI because a fully occluded coronary artery needs rapid clot dissolution to restore blood flow and limit heart muscle damage. The benefit is greatest in the first hours after symptoms begin, so a patient presenting within about 12 hours with ST-segment elevation on ECG is the scenario where fibrinolysis is appropriate, especially if primary PCI isn’t available promptly. In NSTEMI, the artery is usually not completely occluded, so fibrinolytics are not the standard therapy. A chest pain patient with a normal ECG wouldn’t have STEMI, so fibrinolysis wouldn’t be indicated. If ST segments improve after therapy, that suggests reperfusion has occurred, which changes management away from ongoing lysis.