Korean Circ J.  2013 Nov;43(11):766-769. 10.4070/kcj.2013.43.11.766.

Simultaneously Presented Acute Ischemic Stroke and Non-ST Elevation Myocardial Infarction in a Patient with Paroxysmal Atrial Fibrillation

• Kim HL
• Seo JB
• Chung WY
• Zo JH
• Kim MA
• Kim SH

• KMID: 2224809
• DOI: http://doi.org/10.4070/kcj.2013.43.11.766

Abstract

Although atrial fibrillation is the most frequent cause of embolic stroke, coronary embolism from atrial fibrillation is a very rare cause of acute myocardial infarction. Therefore, simultaneously presented acute ischemic stroke and acute myocardial infarction due to atrial fibrillation in the same patient has not been documented. The present report describes the case of a 58-year-old man with paroxysmal atrial fibrillation who initially presented with a large cerebral infarction due to embolic occlusion of the left middle cerebral artery. Four hours after the diagnosis of cerebral embolism, he was subsequently diagnosed with acute myocardial infarction due to concurrent coronary embolism. He underwent successful coronary revascularization with a drug-eluting stent. The possibility of combined coronary embolism as a rare etiology should be kept in mind when a patient with acute embolic stroke presents, especially when there is evidence of acute myocardial infarction.

Keyword

Atrial fibrillation; Cerebral infarct; Embolism; Myocardial infarction; Percutaneous transluminal coronary angioplasty

MeSH Terms

Angioplasty, Balloon, Coronary
Atrial Fibrillation*
Cerebral Infarction
Diagnosis
Drug-Eluting Stents
Embolism
Humans
Intracranial Embolism
Middle Aged
Middle Cerebral Artery
Myocardial Infarction*
Stroke*

Figure

• 

  Fig. 1 Serial electrocardiograms of the patient. A: electrocardiogram (ECG) at initial presentation. B: ECG showing atrial fibrillation with fast ventricular response. C: ECG showing dynamic ST-segment depressions in multiple leads. D: ECG after percutaneous coronary intervention showing sinus rhythm without ST-segment changes.

• 

  Fig. 2 Acute large middle cerebral artery infarction shown in diffusion-weighted scan of brain magnetic resonance image (A) and magnetic resonance cerebral angiography (arrow) (B).

• 

  Fig. 3 Left coronary angiography showing a large thrombus located in the mid-portion of the left anterior descending artery (A, arrow), which completely disappeared after stent implantation (B).

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