Concomitant acute right ventricular infarction and ischemic cerebrovascular stroke; possible explanations

Abstract

Concomitant acute myocardial infarction and ischemic cerebrovascular accidents has been rarely reported in the literature. In this report, we are describing a 48 year old male patient who presented with acute infero-posterior and right ventricular transmural myocardial infarction followed within one hour with massive cerebral infarction and deep coma. The patient succumbed to cardiogenic shock and fatal ventricular arrhythmias resistant to aggressive resuscitative efforts. This association can best be described as "cardio-cerebral infarction". The authors suggest that there exist a possible relationship between both pathologies rather than being just a mere coincidence. Explanations for this association are thoroughly explored and discussed. Early recognition of such cases is important and determines the patient's further management and prognosis. This report aims to sensitize readers to this rare and critical scenario and highlights the necessity of further research for the ideal management of this situation.

Figure 1

Revealing pathological Q waves and ST segment elevation in leads II, III, aVF with reciprocal ST segment depression in the lateral leads.

Figure 2

Right precordial leads revealing ST segment elevation in V3R and V4R denoting right ventricular infarction.

Figure 3

Apical 4-chamber view revealing a markedly dilated right ventricle with an end-diastolic diameter of 4.15 cm. There is no evidence of right ventricular or left ventricular thrombus.

Figure 4

Revealing hypodense areas in both occipital lobes, brain stem and both cerebellar hemispheres denoting massive infarction in the basilar artery territory.