Thrombolysis with intravenous tissue (IV)
plasminogen activator (tPA) is considered for patients with
acute ischemic stroke falling within the described inclusion criteria defined by The National Institute of Neurological Disorders and Stroke (NINDS) rtPA trial. Complications of IV thrombolysis with tPA are commonly related to
hemorrhage,
anaphylaxis, or
arterial occlusion. We describe two cases of acute
myocardial infarction (MI) following IV tPA infusion for
acute stroke. One of the patients had underlying
ischemic heart disease (IHD) while the other did not have any prior IHD. Both had presented with
acute ischemic stroke within the window period of thrombolysis and had no
contraindications for thrombolysis. Both the patients succumbed due to
myocardial infarction and cardiovascular collapse due to new onset arrhythmias. Acute MI immediately following IV tPA for
stroke is a rare but serious complication. The disruption of intracardiac
thrombus and subsequent embolization to coronary arteries may be an important mechanism in the occurrence of MI after administration of tPA for
acute ischemic stroke. As both the patients succumbed before the arrangement for coronary angiography, the demonstration of intracardiac or intracoronary
thrombus was not possible. But clinically, the presence of
chest pain with elevated
troponin levels and ST segment elevation pointed to MI. We suspect that fragmentation and lysis of intracardiac
thrombus may result in MI after use of tPA for
acute ischemic stroke, though the remote possibility of simultaneous occurrence of two atherosclerotic events MI and
stroke exists.