Hemopericardium and tamponade following intracoronary thrombolysis with streptokinase

Area of Science:

• Cardiology
• Cardiac Surgery
• Pharmacology

Background:

• Acute myocardial infarction (AMI) is a leading cause of cardiac mortality.
• Intracoronary thrombolysis with streptokinase is a reperfusion strategy for AMI.
• Complications of AMI and its treatment require careful management.

Purpose of the Study:

• To report a rare complication of intracoronary streptokinase therapy for AMI.
• To describe the successful management of hemopericardium and cardiac tamponade post-thrombolysis.
• To evaluate the efficacy of subxiphoid pericardial window in this specific clinical scenario.

Main Methods:

• Case report of two patients with AMI treated with intracoronary streptokinase.
• Diagnosis of hemopericardium and pericardial tamponade.
• Surgical intervention via subxiphoid pericardial window.
• Assessment of left ventricular function and patient recovery.

Main Results:

• Both patients developed hemopericardium and cardiac tamponade after streptokinase reperfusion therapy.
• Despite successful artery reopening, left ventricular function remained impaired.
• Subxiphoid pericardial window effectively relieved cardiac tamponade in both cases.
• Patients experienced good recovery following the surgical intervention.

Conclusions:

• Hemopericardium is a rare but serious complication of streptokinase reperfusion in AMI, particularly when cardiac rupture or anticoagulation is absent.
• This complication may be specific to reperfusion with streptokinase.
• Pericardial window is a potentially safer alternative to pericardiocentesis due to the risk of cardiac rupture.