Neurocritical Care

, Volume 13, Issue 2, pp 261–262

Cardiac Rupture After Intravenous t-PA Administration in Acute Ischemic Stroke

  • Amar Dhand
  • Kazuma Nakagawa
  • Seema Nagpal
  • Jeffrey M. Gelfand
  • Anthony S. Kim
  • Wade S. Smith
  • Tarik Tihan
Practical Pearl

Abstract

Background

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.

Methods

Case report.

Results

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.

Conclusions

This case illustrates a fatal cardiac complication of IV thrombolytic therapy for stroke. The speculated mechanism is hemorrhage into the infarcted myocardium.

Keywords

Ischemic stroke Myocardial infarction IV t-PA Cardiac rupture 

References

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    Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38:1655–711.CrossRefPubMedGoogle Scholar
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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Amar Dhand
    • 1
  • Kazuma Nakagawa
    • 1
  • Seema Nagpal
    • 1
  • Jeffrey M. Gelfand
    • 1
  • Anthony S. Kim
    • 1
  • Wade S. Smith
    • 1
  • Tarik Tihan
    • 2
  1. 1.Department of NeurologyUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Neuropathology UnitUniversity of California San FranciscoSan FranciscoUSA

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