Fuchs Flávio Danni, Amon André Barcellos, Borges Aníbal Pires, Fuchs Felipe Costa, Gonçalves Sandro Cadaval
Division of Cardiology, Graduate Program in Cardiology, School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Porto Alegre, RS 90035-903, Brazil.
Eur Heart J Case Rep. 2024 Nov 15;8(12):ytae605. doi: 10.1093/ehjcr/ytae605. eCollection 2024 Dec.
Sequential occurrences of acute ischaemic stroke in patients with acute myocardial infarction (MI) and vice versa have been reported, but not the simultaneous occurrence of both conditions. We report a case of simultaneous occurrence of MI and systemic embolism caused by a mechanism not reported to date.
A 52-year-old female patient presented with concurrent chest pain, right arm weakness, and dysphasia. An electrocardiogram demonstrated ST-elevation MI. A computed tomography angiography ruled out aortic dissection and showed an ischaemic stroke and infarction in the right kidney and spleen. A right coronary thrombotic occlusion at the ostium was successfully recanalized. Transoesophageal echocardiography showed preserved left ventricular function with no intracardiac thrombi.
The reported case presentation does not align with the mechanisms typically associated with simultaneous MI and stroke. The most plausible hypothesis is that the thrombus in the right coronary ostium extended into the aorta, resulting in a concurrent systemic embolism.
已有报道称急性心肌梗死（MI）患者会相继发生急性缺血性卒中，反之亦然，但两种情况同时发生的情况尚未见报道。我们报告一例由迄今未报道的机制导致的MI和系统性栓塞同时发生的病例。
一名52岁女性患者同时出现胸痛、右臂无力和言语困难。心电图显示ST段抬高型心肌梗死。计算机断层血管造影排除了主动脉夹层，并显示右肾和脾脏有缺血性卒中和梗死。右冠状动脉开口处的血栓性闭塞成功再通。经食管超声心动图显示左心室功能正常，无心腔内血栓。
报道的病例表现与通常与MI和卒中同时发生相关的机制不符。最合理的假设是右冠状动脉开口处的血栓延伸至主动脉，导致同时发生系统性栓塞。
