Shayo Sigfrid Casmir, Khanbai Khuzeima, Gandye Yona, Lwakatare Flora, Kiroga Nakigunda, Waane Tatizo, Kisenge Peter
Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania.
Department of Radiology, Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania.
Egypt Heart J. 2024 Dec 25;76(1):161. doi: 10.1186/s43044-024-00593-0.
Concurrent ST-elevation myocardial infarction (STEMI) and acute ischemic stroke (AIS) are extremely rare, and their management remains perplexing due to the absence of high-quality evidence and limited resources. For the first time, we report a rare, preventable, and suboptimally managed case of concurrent AIS and STEMI in a patient with non-Hodgkin lymphoma (NHL) who received cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy.
A 59-year-old postmenopausal woman of African origin with a background history of type 2 diabetes mellitus presented to the Jakaya Kikwete Cardiac Institute with sudden onset of left-sided weakness and typical ischemic chest pain for 3 days. The patient was recently diagnosed with NHL and started CHOP chemotherapy 3 weeks prior. Physical examination revealed left-sided hemiplegia. Emergency brain computed tomography and 12-lead echocardiography (ECG) revealed AIS and STEMI, respectively. A diagnosis of concurrent AIS and STEMI was reached, and the patient was loaded with dual antiplatelets and heparin and rushed for emergency coronary angiography (GAG) and percutaneous coronary intervention (PCI). CAG revealed massive thrombotic occlusion of the mid-segment of the left anterior descending coronary artery (mLAD) and proximal segment of the right coronary artery. Revascularization was achieved in both vessels with a resultant TIMI flow grade of 3. The post-PCI period was marked by significant improvement in chest pain and resolution of ST-elevation, as revealed by 12-lead ECG. However, the patient remained hemiplegic.
We have described a rare case of concurrent AIS and STEMI in a postmenopausal woman who had a significant risk of thromboembolism. The patient had uncontrolled type 2 diabetes and received CHOP chemotherapy for NHL, which was diagnosed 3 weeks prior. This case underscores the need for thromboembolic prophylaxis for selected cancer patients receiving chemotherapy. The need to individualize management is also emphasized, as both PCI and thrombolysis carry the risk of serious repercussions. In our patient, if thrombolysis was attempted it would have caused myocardial rupture and immediate death. The patient would have benefited from endovascular mechanical embolectomy for AIS; however, this practice is lacking at our institution. This calls for the establishment and strengthening of neurointerventional practices in our tertiary healthcare facilities.
同时发生的ST段抬高型心肌梗死（STEMI）和急性缺血性卒中（AIS）极为罕见，由于缺乏高质量证据且资源有限，其治疗仍令人困惑。我们首次报告了一例罕见的、可预防的且治疗欠佳的病例，该病例为一名非霍奇金淋巴瘤（NHL）患者在接受环磷酰胺、阿霉素、长春新碱和泼尼松（CHOP）化疗时并发AIS和STEMI。
一名59岁的绝经后非洲裔女性，有2型糖尿病病史，因突然出现左侧肢体无力和典型缺血性胸痛3天就诊于贾卡亚·基奎特心脏病研究所。该患者最近被诊断为NHL，并在3周前开始接受CHOP化疗。体格检查发现左侧偏瘫。急诊脑部计算机断层扫描和12导联心电图（ECG）分别显示为AIS和STEMI。确诊为AIS和STEMI并发，该患者接受了双联抗血小板药物和肝素治疗，并紧急进行冠状动脉血管造影（GAG）和经皮冠状动脉介入治疗（PCI）。冠状动脉血管造影显示左前降支冠状动脉中段（mLAD）和右冠状动脉近端大量血栓性闭塞。两支血管均实现了血运重建，最终TIMI血流分级为3级。12导联心电图显示，PCI术后胸痛明显改善，ST段抬高消失。然而，该患者仍为偏瘫。
我们描述了一例绝经后女性并发AIS和STEMI的罕见病例，该患者有显著的血栓栓塞风险。该患者2型糖尿病控制不佳，且在3周前被诊断为NHL并接受CHOP化疗。该病例强调了对接受化疗的特定癌症患者进行血栓栓塞预防的必要性。同时也强调了个体化治疗的必要性，因为PCI和溶栓均有严重不良反应的风险。在我们的患者中，如果尝试溶栓，将会导致心肌破裂和立即死亡。该患者本可从针对AIS的血管内机械取栓术中获益；然而，我们机构缺乏这种治疗手段。这就要求在我们的三级医疗保健机构中建立并加强神经介入治疗手段。
