Acute Ischemic Stroke with Acute Myocardial Infarction, Neurologist or Cardiologist First? A Rarely Reported Case

Introduction: Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) are both life-threatening medical conditions, bringing lethal prognosis if not addressed immediately. Cardio-cerebral infarction (CCI) term can be used to describe the simultaneous incident of AIS and AMI. However, the approach to immediate management of CCI remains unclear. Case Illustration: A 51-year-old-man was brought to hospital complaining right-sided paresis without chest pain within 1 hour onset. Vital signs were stable on initial evaluation, with electrocardiography showing: sinus rhythm, HR 120 bpm and anteroseptal wall infarction. CCI was confirmed by non-contrast head computed tomography (CT) scan, showing temporal infarction, and rising Troponin I level. Discussion: Neurologist was contacted first due to the chief complain, ordering: intravenous Actilyse and Manitol; oral Aspilet, Clopidogrel and Atorvastatin; and intensive care unit admission with interspecialty refferal to cardiologist. After 3 hours, left chest discomfort started growing, hence Furosemid and Morfin were administered by cardiologist. Patient dropped to somnolen state on second day, therefore subcutaneous Diviti and oral Carvilol were prescripted. On third day patient regained his conscioussness and chest discomfort were relieved. On day five, physioteraphy was scheduled and echocardiography was performed showing ischaemic cardiomyopathy with reduced ejection fraction. Thrombus was found on left ventricular apical explaining why CCI could happen. Result: Patient was discharged after 8 days treatment with a better right-side motoric strength. Conclusion: This case report shows that neurologist and cardiologist collaboration is needed to take the best decisions for CCI patient, resulting a better outcome that leads to reduction of mortality and morbidity.