Simultaneous onset of myocardial infarction and ischemic stroke in a patient with atrial fibrillation: Multiple territory injury revealed on angiography and magnetic resonance

An 84-year-old man with a history of hypertension and paroxysmal atrial fibrillation (AF) who received no anticoagulant drugs experienced acute chest pain and transient loss of consciousness. He was transferred to our emergency room. His initial electrocardiogram showed sinus rhythm with ST-segment elevation in the I, aVL, and V1–V6 leads. His blood pressure was 158/92mmHg and his pulse was regular at 70beats per minute. A chest radiograph showed increased heart size and pulmonary vascular congestion. His troponin T level was elevated (more than 0.1ng/mL). He was diagnosed with ST-elevation myocardial infarction (MI) and we decided to perform percutaneous coronary intervention as a priority, though he also complained of left hemiparesthesia. Emergency coronary angiography (CAG) showed a normal right coronary artery and occlusion of both the mid left anterior descending artery (LAD) and the posterolateral (PL) branch of the left circumflex artery (LCX) (A–C). After crossing a guidewire to the distal LAD, successful recanalization of the LAD was achieved by simple aspiration of the thrombus, and no significant stenosis remained in the LAD. Subsequently, we similarly recanalized the LCX by aspiration only (D–F). After removing the emboli, no further intervention was necessary. In the intensive care unit, the patient's left hemiparesthesia improved, but a neurologist presumed it to be the result of stroke with an NIH Stroke Scale point 1. A transthoracic echocardiogram reve...
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Online Letters to the Editor Source Type: research