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A 56 yr old man with known ishaemic heart presented with severe chest pain for 1 hr to ER. On immediate EKG there was elevated ST in leads V3-V6. The patient was treated with opaites, oxygen & nitrates. Vitals Bp 120/82, pulse 90/min regular, sao2 98% with 3 lits 02. The patient was planned for PTCA but due to non availability of PTCA immediately he was thrombolysed with Streptokinase. When infusion was running the patient suddenly had a change in EKG for 30 secs which reverted automatically. The EKG shown below. This short term EKG change continues to happen. The vitals r still the same.

See new EKG Change here
http://tinypic.com/r/2zfnajr/5

What of the following statements are correct?

a. There is new onset infarct which leading to this change
b. This is expected during thrombolysis.
c. This common side effect of streptokinase thats why it is usually replaced by alteplase.
d. The patient needs immediate cardioversion
e. The thrombolysis should be stopped when this sort of arrythmias happen.

Answer is B. Non-sustained VTach is exepcted after reperfusion It's benign. Just observe.

can u explain more heist y this is happening

B... V tach which reverses within 30 sec without hemodynamic probs.... Is it due to reperfusion of ischemic myocardium...? does it increase automaticity due to reperfusion?

When reperfusion happens there is sudden increase in blood flow in the partially infarcted area which suddenly creates an ectopic focus for increased automaticity in myocardium

correct ans is B reperfusion arrythmia non sustained Vtach ...expected in thrombolysis