Non-ST elevation myocardial infarction with multivessel disease and anoxic brain injury: a case report

A 71-year-old black male with a history of hypertension, dyslipidemia, type 2 diabetes, history of bladder cancer status-post resection now in remission, history of multiple transient ischemic attacks, and coronary artery disease (CAD) presented with non-exertional substernal chest pain radiating to the left arm, accompanied by shortness of breath and nausea. Initial evaluation revealed elevated troponins and nonspecific electrocardiogram changes, consistent with non-ST elevation myocardial infarction. Coronary angiography demonstrated severe multivessel disease, including critical left main stenosis. Post-procedurally, the patient developed anoxic brain injury, likely due to a hypoxic event, leading to acute hydrocephalus and transtentorial herniation. Despite aggressive management, the patient experienced progressive neurologic decline, necessitating palliative care consultation. This case highlights the complexities of managing severe CAD in high-risk patients and the devastating consequences of peri-procedural complications.