Hyperacute synchronous cardiocerebral infarction (CCI) is an extremely rare condition with an incidence of 0.009%. In the acute stage of ischemic stroke, there is a high prevalence of ECG abnormalities. Prolonged QTc, atrial fibrillation (AF) and ECG changes indicative of ischemic heart disease, such as Q waves, ST depression, and T wave inversion, were the most prevalent changes. There are three types of simultaneous CCI: cardiac conditions that cause cerebral infarction, cerebral infarction caused by cardiac conditions, and (c) dysregulation of the brain–heart axis or cerebral infarction causing myocardial infarction. Herein, we present a case of hyperacute synchronous CCI in an elderly patient with new-onset AF and myocardial infarction with nonobstructive coronary arteries (MINOCA).

Keywords:

References

1. Yeo LLL, Andersson T, Yee KW et al. Synchronous cardiocerebral infarction in the era of endovascular therapy: which to treat first? J. Thromb. Thrombolysis 44(1), 104–111 (2017).
MedlineGoogle Scholar
2. Omar HR, Fathy A, Rashad R, Helal E. Concomitant acute right ventricular infarction and ischemic cerebrovascular stroke; possible explanations. Int. Arch. Med. 3, 25 (2010).
MedlineGoogle Scholar
3. Ng TP, Wong C, Leong ELE et al. Simultaneous cardio-cerebral infarction: a meta-analysis. QJM: Mon. J. Assoc. Physicians 115(6), 374–380 (2022).
Medline CASGoogle Scholar
4. Kijpaisalratana N, Chutinet A, Suwanwela NC. Hyperacute simultaneous cardiocerebral infarction: rescuing the brain or the heart first? Front. Neurol. 8, 664 (2017).
MedlineGoogle Scholar
5. Fure B, Bruun Wyller T, Thommessen B. Electrocardiographic and troponin T changes in acute ischaemic stroke. J. Intern. Med. 259(6), 592–597 (2006).
Medline CASGoogle Scholar
6. Tahsili-Fahadan P, Geocadin RG. Heart-brain axis: effects of neurologic injury on cardiovascular function. Circ. Res. 120(3), 559–572 (2017).
Medline CASGoogle Scholar
7. Collet JP, Thiele H, Barbato E et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur. Heart J. 42(14), 1289–1367 (2021).
MedlineGoogle Scholar
8. Pathik B, Raman B, Mohd Amin NH et al. Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging. Eur. Heart J. Cardiovasc. Imaging 17(10), 1146–1152 (2016).
MedlineGoogle Scholar
9. Redfors B, Råmunddal T, Shao Y, Omerovic E. Takotsubo triggered by acute myocardial infarction: a common but overlooked syndrome? J. Geriatr. Cardiol. 11(2), 171–173 (2014).
MedlineGoogle Scholar
10. Powers WJ, Rabinstein AA, Ackerson T et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 50(12), e344–e418 (2019).
MedlineGoogle Scholar
11. Ibanez B, James S, Agewall S et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 39(2), 119–177 (2018).
MedlineGoogle Scholar
12. Berge E, Whiteley W, Audebert H, De Marchis GM, Fonseca AC. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. 6(1), I–LXII (2021).
Google Scholar
13. Bálint A, Tornyos D, El Alaoui El Abdallaoui O, Kupó P, Komócsi A. Network meta-analysis of ticagrelor for stroke prevention in patients at high risk for cardiovascular or cerebrovascular events. Stroke 52(9), 2809–2816 (2021).
MedlineGoogle Scholar
14. Tornyos D, Komócsi A, Bálint A et al. Antithrombotic therapy for secondary prevention in patients with stroke or transient ischemic attack: a multiple treatment network meta-analysis of randomized controlled trials. PLOS ONE 17(8), e0273103 (2022).
Medline CASGoogle Scholar
15. Szapáry L, Tornyos D, Kupó P, Lukács R, El Alaoui El Abdallaoui O, Komócsi A. Combination of antiplatelet and anticoagulant therapy, component network meta-analysis of randomized controlled trials. Front. Cardiovasc. Med. 9, 1036609 (2022).
Medline CASGoogle Scholar
16. Elnour AA, Komócsi A, Kupó P et al. The role of direct oral anticoagulant in patients with acute coronary syndrome on single or dual antiplatelet regime: review of opportunities and challenges. Curr. Rev. Clin. Exp. Pharmacol. 16(1), 52–63 (2021).
Medline CASGoogle Scholar

Vol. 19, No. 6

Supplemental Materials

Metrics

Downloaded 57 times

History

Received 27 December 2022

Accepted 30 June 2023

Published online 14 July 2023

Published in print May 2023

Information

Keywords

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.futuremedicine.com/doi/suppl/10.2217/fca-2022-0136

Author contributions

PE Papakonstantinou wrote the manuscript and took care of the patient with support from ME Lentza. K Manousiadis reviewed the literature and took care of the patient. I Bei reviewed the manuscript and took care of the patient. M Panourgia reviewed the literature and took care of the patient. D Tachmetzidi-Papoutsi interpreted the data and reviewed the manuscript. S Xydonas and A Sideris critically reviewed and supervised the manuscript. S Xydonas and A Sideris contributed equally to this work. All the authors contributed to the article and gave final approval.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The case report was internally reviewed and approved by the Department of Cardiology, Evangelismos Hospital (Athens, Greece). The patient reported in this case is deceased. Verbal consent was obtained from the patient's next-of-kin. Every effort has been made to anonymize the case.

Data sharing statement

All data relevant to the study are included in the article. Upon a reasonable request, the authors will make the data, methods used in the analysis available to any researcher for purposes of reproducing the results or replicating the procedure.

PDF download