A 76-year-old man arrives at the emergency department complaining of severe midsternal chest pain and diaphoresis. A history of hypertension, type 2 diabetes, and asymptomatic right carotid artery stenosis is significant. His blood pressure is 120/70 mm Hg, and his pulse rate is 75 beats per minute. Auscultation reveals that the lungs are clear. The ECG reveals ST segment elevations of more than 1 mm in leads II, III, and aVF. Aspirin is given to the patient immediately upon arrival, followed by alteplase and a low-dose beta blocker. For pain relief, a single intravenous dose of morphine is administered. The patient is discovered to be comatose several hours later, with asymmetric pupils and an irregular breathing pattern. What is the most likely cause of this patient's current condition?

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Quizplus · Accepted Answer

Eductional Objective: Fibrinolytic therapy for acute ST segment elevation myocardial infarction is a reasonable reperfusion technique for patients with no contraindications to thrombolysis.  Fibrinolytic agents such as alteplase bind to fibrin in the thrombus (clot) and activate plasmin, which leads to thrombolysis.  The most common adverse effect of thrombolysis is hemorrhage (eg, gastrointestinal, intracerebral).

A 76-Year-Old Man Arrives at the Emergency Department Complaining of Severe