Abstract Objective Cerebral hypoxia and acute encephalitis subsequent to myocardial infarction (MI) are often associated with a decline in cognitive functioning (Wang et al., 2022; Caplan, 2004). While this relationship is well documented in existing literature, less research has investigated the potential nuanced cognitive and behavioral impacts of hypoxia and encephalitis due to electrocution-induced atrial fibrillation (AFib). The present case study uses neuropsychological assessment to clarify further the impact of significant electrocution and subsequent morbidities on cognition. Method We present a case study of a 30-year-old right-handed transgender female with 12 years of education who was referred for neuropsychological assessment pursuant to mental status changes manifested by disorientation and amnesia (the patient believed it was ten years prior) following the MI due to electrocution complicated by an estimated period of 10–15 minutes of non-responsiveness and anoxic encephalopathy. Results Neuropsychological assessment revealed difficulties with cognitive efficiency, language functioning, sequencing, problem-solving, complex attention, and semantic fluency. Overall, performance was inconsistent with education-weighted norms and estimated premorbid functioning. An objective measure of psychological functioning reflected a negative self-evaluation, depression, thoughts of self-harm, anxiety, and personality difficulties marked by fluctuating emotions. Findings supported a diagnosis of cognitive impairment and altered mental status associated with anoxic brain injury from the above-noted MI. Conclusion This case highlights the consequences of anoxic encephalopathy from MI subsequent to electrocution on cognitive, emotional, and behavioral functioning. Neuropsychological assessment provided clear evidence of cognitive impairment beyond the initial diagnoses, and further defined cognitive and behavioral correlates not explained by other dispositional variables.