Incidence et signification des troubles du rythme précoces après traitement fibrinolytique de l'infarctus du myocarde.

: The study concerns 31 cases of parenteral fibrinolysis performed at the acute stage of myocardial infarction in 30 patients (mean age: 51.9 years), treated less than 4 hours and 15 minutes after the onset of pain. The treatment with streptokinase (80.65%), BRL 26 921 (12.90%) and urokinase (6.45%) was undertaken within a mean time of 3 hours and 17 minutes +/- 53 min. Revascularization defined by the disappearing of pain, the sudden flattening of ST with presence of Q wave, was obtained in 71 p. cent of patients before the 6th hour. The study of the CK curve shows that the enzymatic peak is reached earlier in these patients (13 hours 23 vs 19 h 42). Severe arrhythmias are rare (VF: 0%, transient AVB III: 3.2%). VAIRs were only observed in patients revascularized at an early stage (p 0.02) and in 54.5 p. cent of them. It seems to concern the largest M.Is, treated and revascularized later, regardless of the artery concerned. The syndrome bradycardia-hypotension (Bezold-Jarisch reflex) is only found in patients revascularized at an early stage (22.7 p. cent). Late VES (RR' RR-200 ms or fusion) are more frequent in patients revascularized at an early stage. These three benign rhythm disorders which do not usually require treatment, seem to be good success criteria of fibrinolysis but cannot be considered as predictive indications of myocardial protection.