Introduction: Despite the common occurrence of streptokinase-induced hypotension among patients with acute myocardial infarction, the underlying pathophysiology remains obscure and poorly understood. Our study aimed to pool clinical evidence on the potential mechanism of streptokinase-induced hypotension through a systematic review of the literature. Material and methods: We conducted literature search from Medline, Scopus and Web of Science on clinical studies related to streptokinase-induced hypotension. Results: Our search yielded 972 citations. After removal of duplicates, 878 articles were screened for eligibility, of which 856 papers were excluded due to various reasons. Of the remaining 22 articles retrieved with full texts, eight relevant articles were selected for final analysis. Three themes emerged as the proposed mechanisms of streptokinase-induced hypotension, including (i) reduction in total peripheral resistance, (ii) complement activation, and (iii) dismissal of hypotheses involving other intermediaries. Conclusions: Our findings suggest that the underlying mechanism of streptokinase-induced hypotension lies primarily in the reduction in total peripheral resistance.
A 27-year-old Malaysian woman with prior history of recurrent unexplained episodes of syncope was diagnosed in adulthood with Scimitar syndrome, a rare form of partial anomalous pulmonary venous return (PAPVR). Consequently, she underwent a corrective right pulmonary vein to left atrium baffle surgery. Postoperatively, she was readmitted for pleurisy and haemoptysis, with no evidence of respiratory distress. Subsequent workup with computed tomography of pulmonary angiography (CTPA) revealed the presence of a filling defect in the right main pulmonary artery, mimicking a pulmonary embolism. However, in view of atypical presentation and altered cardiopulmonary flow dynamics, a cardiac magnetic resonance (CMR) angiography imaging was performed demonstrating patent right pulmonary artery on delayed phase acquisition with narrowed surgical baffle. The diagnosis of pulmonary embolism was revised. This case highlights the importance of understanding the pathophysiology and flow mechanics of congenital cardiovascular diseases as well as the diagnostic imaging of choice.
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