Abstract
Concurrent acute ischemic stroke and acute myocardial infarction is an uncommon medical emergency condition. The challenge for the physicians regarding the management of this situation is paramount since early management of one condition will inevitably delay the other. We present two illustrative cases of “hyperacute simultaneous cardiocerebral infarction” who presented with simultaneous cardiocerebral infarction and arrived at the hospital within the thrombolytic therapeutic window for acute ischemic stroke of 4.5 h. We propose an algorithm for managing the patient with hyperacute simultaneous cardiocerebral infarction based on hemodynamic status and suggest close cardiac monitoring based on the site of cerebral infarction.
Highlights
Both acute ischemic stroke and acute myocardial infarction are medical emergency conditions, which require timely diagnosis and management
We propose the term “hyperacaute simultaneous cardiocerebral infarction” to describe patients with simultaneous cardiocerebral infarction who arrived at the hospital within 4.5 h of the thrombolytic therapeutic window
Pathophysiology of simultaneous cardiocerebral infarction can be classified into three categories: [1] conditions leading to concurrent cerebral–coronary infarction, [2] cardiac conditions leading to cerebral infarction, and [3] brain–heart axis dysregulation or cerebral infarction leading to myocardial infarction
Summary
Both acute ischemic stroke and acute myocardial infarction are medical emergency conditions, which require timely diagnosis and management. It has been shown that acute ischemic stroke increases the risk of acute myocardial infarction and vice versa [1, 2]. Simultaneous acute ischemic stroke and acute myocardial infarction previously described as “cardiocerebral infarction” has been rarely reported [3]. We propose the term “hyperacaute simultaneous cardiocerebral infarction” to describe patients with simultaneous cardiocerebral infarction who arrived at the hospital within 4.5 h of the thrombolytic therapeutic window. Due to the rarity of the condition, the management of these patients is very challenging and there is no ideal recommendation. From our experience at King Chulalongkorn Memorial Hospital, we present two cases of hyperacute simultaneous cardiocerebral infarction and propose an algorithm for patient management in this challenging situation
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