Cardiac rupture after intravenous t-PA administration in acute ischemic stroke.
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.
Dhand
Amar
A
Department of Neurology, University of California San Francisco, 505 Parnassus Avenue, Box 0114, San Francisco, CA 94143-0114, USA. Amar.Dhand@ucsf.edu
Nakagawa
Kazuma
K
Nagpal
Seema
S
Gelfand
Jeffrey M
JM
Kim
Anthony S
AS
Smith
Wade S
WS
Tihan
Tarik
T
D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D006341:Heart Rupture / Q000139:chemically induced / Q000209:etiology*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000188:drug therapy; D007262:Infusions, Intravenous; D009206:Myocardium / Q000473:pathology; D010291:Paresis / Q000209:etiology; D020521:Stroke / Q000150:complications* / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
D010959:Tissue Plasminogen Activator