Asploro Journal of Biomedical and Clinical Case Reports

Asploro Journal of Biomedical and Clinical Case Reports

Khairy M¹, Lu V¹, Ranasinghe N², Ranasinghe L^3*
1Fourth-year Medical Student, California Northstate University College of Medicine, 9700 W. Taron Dr., Elk Grove, California, USA
²Emergency Physician, New York, USA
³Professor of Emergency Medicine, California Northstate University College of Medicine, 9700 W. Taron Dr., Elk Grove, California, USA

Corresponding Author: Leonard Ranasinghe, MD
Address: Professor of Emergency Medicine. College of Medicine, 9700 W. Taron Dr., Elk Grove, California 9757, USA.
Received date: 05 December 2020; Accepted date: 15 January 2021; Published date: 23 January 2021

Citation: Khairy M, Lu V, Ranasinghe N, Ranasinghe L. A Case Report on Concurrent Stroke and Myocardial Infarction. Asp Biomed Clin Case Rep. 2021 Jan 23;4(1):42-49.

Copyright © 2021 Khairy M, Lu V, Ranasinghe N, Ranasinghe L. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

Keywords: Myocardial Infarction, Cerebral Infarction, Stroke, ST Elevation Myocardial Infarction

Abbreviations: Myocardial Infarction (MI), Percutaneous Coronary Intervention (PCI), Tissue Plasminogen Activator (tPA), Electrocardiogram (ECG), Computerized Tomography (CT), Intravenous (IV), Cardio-Cerebral Infarction (CCI), Left Ventricular (LV), Neurogenic Stunning Myocardium (NSM), High-Sensitivity (HS), American Heart Association/American Stroke Association (AHA/ASA)

Abstract

Concurrent myocardial infarction and acute cerebral infarction is a rare and poorly studied phenomenon that presents a challenge to treat as both conditions are life threatening with narrow therapeutic windows. We present the case of a 70 year old female who presented with symptoms concerning for stroke. However, an electrocardiogram revealed she was also having an acute myocardial infarction. The decision was made to treat the stroke with intravenous tissue plasminogen activator. Unfortunately, the patient ultimately decompensated and died. There are many proposed etiologies of this phenomenon including cardiac thrombi leading to concurrent acute myocardial infarction and cerebral infarction, a primary myocardial infarction leading to a cerebral infarction, and a primary cerebral infarction leading to an acute myocardial infarction. Treatment options include simultaneous mechanical thrombectomy and percutaneous coronary intervention in a cardiac catheterization laboratory, or treating with the intravenous tissue plasminogen activator dose for a cerebral infarction and then potentially also proceeding to percutaneous coronary intervention. Ultimately, the management of this situation will depend on the patient’s specific situation including the type of stroke, the extent of irreversible tissue damage, and the hospital’s available resources. A randomized controlled study is difficult because of the rare occurrence of both presentations and a systematic review of the available literature may provide physicians with better insight as to how to approach a simultaneous acute myocardial infarction and acute cerebral infarction.