Title: Infective endocarditis and t-PA
题目：感染性心内膜炎与t-PA
Author 作者：Feng Xiao （肖锋）
Emergency Physicians face undeniable pressure to treat as many ischemic stroke patients with thrombolysis as possible, and as quickly as possible.
由于许多缺血性脑卒中患者溶栓治疗越快越好，急诊医师面临着不可否认的压力。
Current guidelines for IV t-PA in acute ischemic stroke do not exclude patients with infective endocarditis.
在新的应用静脉t-PA治疗急性缺血性脑卒中的指南中，并没有将感染性心内膜炎的患者列为禁忌症。
However, infective endocarditis-related strokes are associated with a higher risk of hemorrhagic complications and recent experience suggests that IV t-PA use may potentiate that risk and thrombolytic use in patients with IE-associated stroke is associated with very poor outcomes (1,2).
然而，感染性心内膜炎相关的脑卒中具有较高的出血并发症，而近期临床经验表明静脉t-PA的使用可能会增强这一危险和在对由感染性心内膜炎引起的脑卒中应用静脉溶栓预后很差（1,2 ）。
Cerebral complications are the most severe extracardiac complications of infective endocarditis, as well as the most frequent (occurring in 15 - 20% of patients) (3). Ischemic and hemorrhagic stroke precede the diagnosis of infective endocarditis in 60% of patients (3). 


脑的并发症是最严重和最常见的感染性心内膜炎的心外并发症（发生在15 - 20％的患者）（3）。缺血伴出血性脑卒中发生在感染性心内膜炎诊断之前占60％（3）。
Though diagnosis of IE in the acute stroke setting is difficult, clinical features (e.g. fever, a new murmur or worsening of a known murmur, hematuria) may raise concern for IE and should give the physician pause to consider the diagnosis.
虽然在急性脑卒中情况下诊断感染性心内膜炎是非常困难的，临床特征（如发烧，新杂音或恶化的一个已知的杂音，血尿）可能会提高对感染性心内膜炎的警觉，使临床医生来考虑这一诊断。
References 参考文献:

(1) Bhuva P, et al. Neurocrit Care 2010;12: 79-82.

(2) Walker KA, et al. Neurohospitalist 2012; 2:87-91.

(3) Hoen B, et al. N Engl J Med 2013; 368:1425-1433.