Myocardial Infarction Coincident With Cerebrovascular Accidents in the Elderly

Chin, PR; Kaminski, Julyanna Hyczy; Rout, Miss. Ankita

doi:10.1093/ageing/6.1.29

Cited by 41 publications

(27 citation statements)

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“…In clinical studies, myocardial ischemia has been implicated as the cause of ECG changes in LV dysfunction. 12,15,16 However, substantial evidence from animal models suggests that excessive release of catecholamines from sympathetic nerve terminals in the myocardium is a more likely cause of cardiac injury after SAH. 2 The exact mechanism of catecholamine-mediated myocardial damage is unknown, although persistent activation of calcium channels, membrane damage, and microvascular spasm have been proposed as causes.…”

Section: Discussionmentioning

confidence: 99%

Regional Myocardial Perfusion After Experimental Subarachnoid Hemorrhage

Zaroff

Rordorf

Titus

et al. 2000

Stroke

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Background and Purpose-The pathophysiology of cardiac injury after subarachnoid hemorrhage (SAH) remains controversial. Data from animal models suggest that catecholamine-mediated injury is the most likely cause of cardiac injury after SAH. However, researchers also have proposed myocardial ischemia to be the underlying cause, as a result of coronary artery disease, coronary artery spasm, or hypertension and tachycardia. To test the hypothesis that SAH-induced cardiac injury occurs in the absence of myocardial hypoperfusion, we developed an experimental canine model that reproduces the clinical and pathological cardiac lesions of SAH and defines the epicardial and microvascular coronary circulation. Methods-Serial ECG, hemodynamic measurements, coronary angiography, regional myocardial blood flow measurements by radiolabeled microspheres, 2D echocardiography, and myocardial contrast echocardiography were performed in 9 dogs with experimental SAH and 5 controls. Results-Regional wall motion abnormalities were identified in 8 of 9 SAH dogs and 1 of 5 controls (Fisher's Exact Test, Pϭ0.02) but no evidence was seen of coronary artery disease or spasm by coronary angiography and of significant myocardial hypoperfusion by either regional myocardial blood flow or myocardial contrast echocardiography. Conclusions-In this experimental model of SAH, a unique form of regional left ventricular dysfunction occurs in the absence of myocardial hypoperfusion. Future studies are justified to determine the cause of cardiac injury after SAH.

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Section: Discussionmentioning

confidence: 99%

Regional Myocardial Perfusion After Experimental Subarachnoid Hemorrhage

Zaroff

Rordorf

Titus

et al. 2000

Stroke

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“…Evidence over the years has subsequently reported the association between AIS and AMI. Chin et al (1) reported the incidence of CCI as 12.7% in geriatric patients who were screened for AMI within 72 hours of admission for acute stroke. Findings from the Global Registry of Acute Coronary Event (GRACE) trial reported an incidence of in-hospital stroke as 0.9% in a cohort of patients presenting with acute coronary syndrome, and the incidence was much higher in patients with STEMI than the non-STEMI (8).…”

Section: Epidemiologymentioning

confidence: 99%

“…The association between both conditions was recognized few decades ago from several studies, including a 3-year prospective study of AIS patients admitted to the geriatric unit (1). The study showed that 12.7% of these patients had associated AMI within 72 hours of admission.…”

Section: Introductionmentioning

confidence: 96%

Simultaneous acute cardio-cerebral infarction: is there a consensus for management?

et al. 2018

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Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) are both life-threatening medical conditions with narrow therapeutic time-window that carry grave prognosis if not addressed promptly. The acute management of both condition is well documented in the literature, however the management of a simultaneous presentation of both AIS and AMI is unclear. A delayed intervention of one infarcted territory for the other may result in permanent irreversible morbidity or disability, and even death. In addition, the use of antiplatelet and anticoagulants that are inherently part of an AMI management may increase the risk for hemorrhagic conversion associated with intravenous thrombolysis used in AIS, and the use of a thrombolytic in AIS increases the risk of cardiac wall rupture in the setting of an AMI.Despite this ambiguity, there is no clear evidence-based guideline or clinical studies that have addressed the optimal management of this rare co-occurrence. This review paper examines the existing literature on the management of simultaneous acute cardio-cerebral infarction (CCI) and highlights the existing challenge to management.

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“…Concomitant acute myocardial infarction and ischemic cerebrovascular strokes has been rarely reported in the literature [1]. In this report, after the patient has developed acute transmural infero-posterior and right ventricular infarction he suddenly developed a rapid onset and a progressive course of worsening of his conscious level with an NIHSS >25 [2] denoting severe ischemia.…”

Section: Discussionmentioning

confidence: 94%

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

Omar¹,

Fathy²,

Rashad³

et al. 2010

Int Arch Med

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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.

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Myocardial Infarction Coincident With Cerebrovascular Accidents in the Elderly

Cited by 41 publications

References 0 publications

Regional Myocardial Perfusion After Experimental Subarachnoid Hemorrhage

Regional Myocardial Perfusion After Experimental Subarachnoid Hemorrhage

Simultaneous acute cardio-cerebral infarction: is there a consensus for management?

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

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