Heart and Brain Crisis: The Unseen Drama of Acute Cardio-Cerebral Infarction Type 1

Abstract

Background: Cardio-cerebral infarction (CCI) type 1 is a rare condition where acute myocardial infarction (AMI) and acute ischemic stroke (AIS) occur at the same time. The optimal method for diagnosing and treating AMI in patients with AIS remains uncertain. This publication aims to delineate the obstacles associated with the treatment of CCI. Case Illustration: A 69-year-old man with the risk factors hypertension, active smoker, and history of cerebral infarction presented with atypical angina at rest and left hemiparesis. The patient's electrocardiography revealed sinus rhythm and ST elevation with pathological Q wave in the inferoposterior and RV region. The cardiac enzyme level was increased while hs-troponin I was 23.091 ng/L and CKMB was 387 U/L. The Brain CT Scan demonstrated acute infract at lentiformis nucleus dextra and corona radiata dextra. Patient was decided to get loading dual anti-platelet and anticoagulant and performed Primary PCI after bleeding risk assessment. Coronary angiography showed CAD three-vessel disease and left main coronary artery disease with acute total occlusion at mid-RCA with thrombus appearance. The patient underwent coronary stenting in the proximal-mid RCA using DES Cre8 3.0 x 46 mm. Cineangiography evaluation showed TIMI Flow 3 and no residual stenosis. Patient also was joined care with Neurology department to treat AIS simultaneously. Patient improved and was discharged on the 7th day of hospitalization. Conclusion: Effectively managing CCI poses a significant challenge for professionals. PCI strategy for AMI as the first strategy due to high mortality remains the preferred choice despite the risk of hemorrhagic transformation in AIS.