Thrombolytics in infectious endocarditis associated myocardial infarction

The use of thrombolytics in the management of acute myocardial infarction in eligible patients is the accepted standard of practice. We present the case of an embolic myocardial infarction in the setting of acute infectious endocarditis, treated with thrombolytics, resulting in a massive intracerebral hemorrhage and the patient's death. Historical and current literature has shown a consistent and significant incidence of concurrent intracerebral mycotic aneurysms in the setting of infectious endocarditis. Despite this, a literature review of contraindications to the use of thrombolytics rarely recognizes endocarditis as a contraindication. It is imperative that the etiology for myocardial infarction be identified; if contraindications to thrombolytic treatment exist, alternative therapeutic interventions must be pursued. This case highlights the importance of the correct etiologic diagnosis of myocardial ischemia, and increases the awareness of the significant risks of intracerebral hemorrhage associated with the use of thrombolytics in the setting of endocarditis.