Yadav Vijay, Gajurel Ratna Mani, Poudel Chandra Mani, Thapa Paras, Sharma Manju, Shrestha Suraj
Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Kathmandu, Nepal.
Department of Radiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Case Rep Cardiol. 2023 Apr 13;2023:9986712. doi: 10.1155/2023/9986712. eCollection 2023.
Contemporaneous acute myocardial infarction (AMI) and acute ischemic stroke (AIS), termed cardio-cerebral infarction (CCI), is a rare medical emergency. The effectual management of this situation is exigent since early management of one condition will inevitably delay the other. . A 60-year-old woman presented to our hospital with concurrent AMI of the inferior left ventricular wall, complicated by cardiogenic shock and transient complete heart block, and AIS of more than 4.5 hour duration. The cerebral computerized tomography angiography revealed a right-sided terminal internal carotid artery (ICA) occlusion, and the coronary angiogram depicted double vessel disease with a culprit lesion in the right coronary artery (RCA). The patient underwent mechanical thrombectomy for the ICA occlusion by an interventional neuroradiologist followed by the primary percutaneous coronary intervention of the culprit RCA by the interventional cardiologists in the same setting.
A patient with concurrent AMI and AIS is a challenging situation to treat in the emergency department, and the treatment must be individualized for each patient.
同时发生急性心肌梗死(AMI)和急性缺血性卒中(AIS),即心脑梗死(CCI),是一种罕见的医疗急症。由于对一种病症的早期治疗必然会延误另一种病症的治疗,因此有效处理这种情况迫在眉睫。一名60岁女性因并发左心室下壁AMI、合并心源性休克和短暂性完全性心脏传导阻滞以及持续时间超过4.5小时的AIS入住我院。脑部计算机断层血管造影显示右侧颈内动脉(ICA)末端闭塞,冠状动脉造影显示双支血管病变,罪犯病变位于右冠状动脉(RCA)。该患者先由介入神经放射科医生对ICA闭塞进行机械取栓,随后由介入心脏病专家在同一环境下对罪犯RCA进行直接经皮冠状动脉介入治疗。
同时患有AMI和AIS的患者在急诊科治疗具有挑战性,治疗必须针对每个患者进行个体化处理。