Case Report: Initial Management of ST-Elevation Myocardial Infarction Patients with Hypotension in the Emergency Unit of Merauke Regional General Hospital

Abstract

ST-elevation myocardial infarction (STEMI) is a cardiovascular emergency caused by acute coronary artery occlusion that requires immediate reperfusion therapy to limit infarct size and reduce mortality. In healthcare facilities with limited access to primary percutaneous coronary intervention (PCI), fibrinolytic therapy remains an important reperfusion strategy. A 71-year-old man presented to the emergency department with typical chest pain that had begun one hour before admission. The pain radiated to the left arm, left neck, and back and was accompanied by nausea, vomiting, and cold sweats. Electrocardiography (ECG) revealed ST-segment elevation in leads V1–V5, consistent with anteroseptal STEMI with an onset of less than 12 hours. Initial management included oxygen supplementation, dual antiplatelet therapy, anticoagulation, high-intensity statin therapy, intravenous nitrates, and fibrinolytic therapy with 1.5 million units of streptokinase. Ten minutes after fibrinolysis was initiated, the patient developed severe hypotension, with a blood pressure of 60/43 mmHg. Intravenous nitrate therapy was immediately discontinued, and dobutamine infusion was initiated. Following this intervention, the patient's blood pressure increased to 116/69 mmHg, accompanied by improved hemodynamic stability. Early diagnosis and prompt reperfusion therapy are essential in the management of anteroseptal STEMI. Fibrinolytic therapy remains an effective reperfusion option in healthcare facilities with limited access to primary PCI. Close monitoring for hemodynamic complications, particularly hypotension during treatment, is crucial to prevent progression to cardiogenic shock and improve patient outcomes.