Recombinant tissue plasminogen activator treatment for COVID-19 associated ARDS and acute cor pulmonale

•COVID-19 may be characterized by an abnormal coagulation process and microvascular thrombosis of the lung vasculature.•COVID-19 may also be linked with acute respiratory distress syndrome (ARDS) and acute cor pulmonale (ACP).•We confirmed the development of ACP in a patient suffering from COVID-19.•We treated our patient with systemic thrombolysis and this resulted in a marked improvement in hemodynamics.•In addition, there was a significant reduction in hypercapnia, alveolar dead space, and ventilatory ratio. Existing literature highlights the fact that patients with COVID-19 exhibit alterations in the coagulation process and are associated with respiratory and cardiovascular diseases, including acute respiratory distress syndrome and acute cor pulmonale. In this report, we describe the effects of systemic thrombolysis on acute cor pulmonale in a patient suffering from COVID-19. We demonstrated that systemic thrombolysis successfully improved the hemodynamics of our patient and resulted in a prominent reduction in hypercapnia, alveolar dead space, and ventilatory ratio.