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Abstract

 BACKGROUND:Acute myocardial infarction is a major cause of death throughout the world. Many important advanceshave become available to Coronary Care Units enabling them to reduce mortality and improve theprognosis, Reperfusion therapy is one of these important advances.OBJECTIVE:This study sought to identify the Electro-cardiographic (ECG ) changes which occur after receivingAlteplase therapy and its relation to response to thrombolytic therapy.METHODS :Seventy-three patients with ST- elevation Acute Myocardial Infarction (AM I) who received Alteplasewithin 12 hours from the start of symptoms in coronary care unit were included in this study. Electrocardiographic (ECG) was done to all patients at time of arrival to the coronary care unit(CCU),Alteplase therapy was given to all patients plus heparin intravenously, followed by electrocardiographic (ECG ) every 30 minutes for 2 hours.RESULTS:Fifty-seven and half percent of our patients showed 50% reduction in the ST segment elevation in theworst lead after 2 hours from starting Alteplase therapy and regarded as responders. Other ECGchanges like rapid appearance of Q wave, T inversion, accelerated idioventricular rhythm (AIVR) arefound to be specific for reperfusion with a high predictive value when the gold standard criteria wasreduction 50 % in the ST segment elevation Resolution of reciprocal changes is sensitive and specificwith high predictive value.CONCLUSION :Some ECG changes after thrombolytic therapy can predict the response in addition to the alreadyknown changes. 

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