Emergency Medicine Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
Medicine (Baltimore). 2021 Jan 29;100(4):e24496. doi: 10.1097/MD.0000000000024496.
Simultaneous occurrence of acute ischemic stroke and myocardial infarction is reported to have variable precipitating causes. This occurrence has been rarely reported in the literature and described only in very few case reports. During the surge of coronavirus disease (COVID-19) in our region, we noted an increase in the simultaneous occurrence of cardio-cerebral infarction. This led us to explore the possible mechanisms and pathophysiology that could contribute to this increase. The retrospective nature of the study limited us from drawing any conclusion about causation. Rather, we aimed to formulate a hypothesis for future, more rigorous studies.
We present an overview of 5 cases of simultaneous cardio-cerebral infarction that we encountered in our emergency department within 1 month.
In all cases, diagnosis was confirmed using an electrocardiogram, assessment of laboratory cardiac markers, and imaging.
In all cases, dual antiplatelet therapy was started and thrombolysis was held, as the condition was considered high risk in most of the patients. Cardiac catheterization lab was not activated either because the patient was unstable or the risk of COVID-19 in staff outweighed the benefit added in patient treatment.
Two out of 5 patients died because of early complications that lasted for few days. The remaining 3 were discharged from the hospital in moderate functionality for extensive therapy and rehabilitation.
Early recognition and immediate treatment is important in different scenarios leading to thrombosis as the outcome. Additionally, addressing the unknown risks that could contribute to our traditional understanding of these causative mechanisms is important. The hypothesis of exacerbated damage caused by inflammatory and immunological endothelial systemic damage should further be explored to be able to delineate new possibilities in managing these conditions.
急性缺血性脑卒中与心肌梗死同时发生的诱发原因各不相同，据报道其发生率存在差异。这种情况在文献中鲜有报道，仅有少数病例报告。在我们所在地区的冠状病毒病（COVID-19）疫情高峰期，我们注意到同时发生心脑梗死的情况有所增加。这促使我们探讨可能导致这种增加的机制和病理生理学。由于研究的回顾性性质，我们无法得出任何关于因果关系的结论。相反，我们旨在为未来更严格的研究提出假设。
我们介绍了在我们的急诊科在 1 个月内遇到的 5 例同时发生的心脑梗死病例。
所有病例均通过心电图、实验室心脏标志物评估和影像学检查确诊。
所有病例均开始使用双联抗血小板治疗，由于大多数患者的病情被认为风险较高，故未进行溶栓治疗。由于患者不稳定或工作人员感染 COVID-19的风险超过了对患者治疗的益处，故未启用心脏导管实验室。
5 例患者中有 2 例因持续数天的早期并发症而死亡。其余 3 例在接受广泛治疗和康复后从中度功能状态出院。
在不同导致血栓形成的情况下，早期识别和立即治疗很重要。此外，了解可能导致我们对这些因果机制的传统理解产生偏差的未知风险也很重要。应该进一步探讨由炎症和免疫性内皮系统损伤引起的损伤加剧的假设，以便能够在管理这些疾病方面提出新的可能性。
