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02 June 2019 : Case report  USA

Simultaneous Acute Anterior ST-Elevation Myocardial Infarction and Acute Ischemic Stroke of Left Middle Cerebral Artery: A Case Report

Management of emergency care, Rare coexistence of disease or pathology

Omar Obaid1EF*, Hye Rim Smith1EF, Daniel Brancheau1EF

DOI: 10.12659/AJCR.916114

Am J Case Rep 2019; 20:776-779

Abstract

BACKGROUND: Acute ST-elevation myocardial infarction and acute ischemic stroke are both life-threatening conditions with high risk for morbidity and mortality without timely intervention. This simultaneous event has been reported to be as rare as 0.009%. The treatments of both conditions individually have been well documented in the literature and guidelines, but when presenting concomitantly, it poses a unique therapeutic challenge. Immediate treatment of one condition can delay management or even have deleterious effects on the other condition.

CASE REPORT: We present the case of a 41-year-old female with simultaneous acute anterior ST-elevation myocardial infarction and acute left middle cerebral artery ischemic stroke. Due to a low National Institute of Health score she was not a candidate for endovascular treatment and received alteplase per acute ischemic stroke protocol with delayed percutaneous coronary intervention. She was eventually discharged to a long-term acute care facility for continued rehabilitation.

CONCLUSIONS: The co-existence of ST elevation myocardial infarction and acute ischemic stroke is rare, but when these 2 common conditions present simultaneously, it provides a unique therapeutic challenge. Although infrequent, this challenging scenario deserves more recognition and a discussion among the medical community.

Keywords: Anterior Wall Myocardial Infarction, Stroke, Tissue Plasminogen Activator, Brain Ischemia, Infarction, Middle Cerebral Artery, ST elevation myocardial infarction

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923