Dados do Trabalho

Título

Hemopericardium: an uncommon complication of thrombolysis in Stroke

RESUMO

Case
Male 72-year-old patient, with hypertension and a previous hearing loss, started with sudden confusion and aphasia. He was sequentially refered to the tertiary service due to a condition compatible with stroke, presenting a 9 NIHSS on admission. After a brain CT scan without any evidence of hipodensity and ASPECTS of 10, thrombolysis was performed. The procedure was uneventful and there was a complete improvement of the deficit. After 2 days of hospitalization, while waiting the etiologic investigations, the patient started with tachycardia (110 bpm) and respiratory distress requiring oxygen supplementation. A transthoracic echocardiogram was performed, which showed significant pericardial effusion with mild hemodynamic repercussion with right atrial collapse during systole. The Cardiac Surgery’s team quickly attempted an ultrasound-guided subxiphoid drainage, however, it was unsuccessful. Progressively the patient stars with sings of cardiac tamponade, jugular swelling, drowsiness and hypotension (85x55mmHg), and urgent surgical approach was performed with pericardial drainage of 400mL of serohematic fluid. After the procedure, the patient evolved with hemodynamic stability, and underwent a new echocardiogram, with complete improvement of the pericardial effusion. The basic investigation was unremarkable and not show an etiological cause and the patient was discharged for outpatient follow-up.
Discussion
Spontaneous pericardial effusion is a rare complication of thrombolysis in stroke. It is more common when thrombolysis is performed in acute myocardial infarction, in which the patients probably had as a pre-existence cardiomyopathy or pericardiopathy. Mortality is usually very high, due to rapid evolution to cardiac tamponade, but in this case the patient did not have an immediate complication. However, any sings of cardiovascular complications should promptly undergo a cardiac investigation.
Conclusion
As the diagnosis is echocardiographic, in any case of hypotension in the first hours or days of hospitalization, with no other possible clinical causes, an urgent echocardiogram should be performed. And the existence of a cardiac surgery team at the hospital to perform pericardiocentesis or pericardiostomy could be what would save the patient.

Palavras Chave

Hemopericardium, cardiac tamponage, stroke, thrombolysis,