Cardiac Rupture After Intravenous t-PA Administration in Acute Ischemic Stroke
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- Dhand, A., Nakagawa, K., Nagpal, S. et al. Neurocrit Care (2010) 13: 261. doi:10.1007/s12028-010-9384-8
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Ventricular free wall rupture is a fatal complication of myocardial infarction (MI). Although described in MI patients who receive thrombolytic therapy, this complication is not well known in ischemic stroke patients who receive intravenous (IV) t-PA.
We present a 93-year-old woman with an acute onset of a right middle cerebral artery syndrome in the setting of subacute MI. IV t-PA was administered and she subsequently developed asystolic arrest and died. Autopsy showed subacute MI, hemopericardium, and rupture of the left ventricle.
This case illustrates a fatal cardiac complication of IV thrombolytic therapy for stroke. The speculated mechanism is hemorrhage into the infarcted myocardium.