Cardiac rupture after intravenous t-PA administration in acute ischemic stroke

Neurocrit Care. 2010 Oct;13(2):261-2. doi: 10.1007/s12028-010-9384-8.


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.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Brain Ischemia / drug therapy
  • Coronary Artery Disease / complications
  • Female
  • Heart Rupture / chemically induced
  • Heart Rupture / etiology*
  • Humans
  • Infarction, Middle Cerebral Artery / complications
  • Infarction, Middle Cerebral Artery / drug therapy
  • Infusions, Intravenous
  • Myocardium / pathology
  • Paresis / etiology
  • Stroke / complications*
  • Stroke / drug therapy
  • Thrombolytic Therapy / adverse effects
  • Tissue Plasminogen Activator / administration & dosage
  • Tissue Plasminogen Activator / therapeutic use*


  • Tissue Plasminogen Activator