A case of cardiac tamponade during the treatment of simultaneous cardio-cerebral infarction associated with atrial fibrillation – Case report

Abstract

Background: Simultaneous cerebral and myocardial infarction is called cardio-cerebral infarction (CCI). It is a rare condition, and its management strategy has yet to be determined. We report a case of cardiac tamponade during the treatment of CCI associated with atrial fibrillation. Case Description: A 72-year-old man presented with loss of consciousness after chest discomfort. He had taken rivaroxaban for paroxysmal atrial fibrillation. Twelve-lead electrocardiography showed ST elevation at II, III, and aVF. His National Institutes of Health Stroke Scale was 29. We diagnosed him with synchronous cardioembolic stroke and acute myocardial infarction due to atrial fibrillation. The coronary angiography revealed distal occlusion in the posterior descending branch of the right coronary artery, and overall myocardial perfusion seemed sufficient. The diffusion-weighted image showed hyperintense lesions at the cerebellum, and magnetic resonance angiography did not reveal the flow of the basilar artery. The patient’s NIH score improved immediately, so we did not perform intravenous tissue plasminogen activator (IV-tPA) administration nor endovascular treatment. Heparin administration was started. After 38 h from the onset, he suffered from hydrocephalus, and cerebral ventricular drainage was performed. Subsequently, circulatory dynamics worsened, and he was diagnosed with cardiac tamponade. Emergency pericardiotomy was performed, and he has been taking intensive care. Conclusion: Some cases with CCI treated with IV-tPA and endovascular intervention were reported, but the treatment strategy should be still discussed multidisciplinary. Especially, the administration of antithrombotic drugs for CCI should be carefully performed because fatal hemorrhage such as cardiac tamponade can occur.

Concurrent Cardio-Cerebral Infarction – A Case Report and Literature Review

“…Some were not candidates or clinically unstable due to significant cardiac and neuro deficit on presentation, 2,3,8 some were considered high risks for complications associated with such therapies, 2,8,9 and others did not require further intervention with improved symptoms. 5,9 A few patients without contraindications received thrombolysis with IV alteplase (Table 1), which was thought to benefit both MI and AIS. 2,4,10,12,13 However, the dosage of IV alteplase in CCI has been a topic of debate as a higher dose is recommended in MI alone 14 as compared to AIS alone.…”

Endovascular therapy for cardiocerebral infarction associated with atrial fibrillation: A case report and literature review

“…[ 2 , 15 ] The possible causes of CCI were considered as follows: (1) most commonly, AF caused both cardiac and cerebral embolization (Cases 2, 6, and the present case);[ 2 , 15 ] (2) AMI, especially in the anterior wall and apex, with weakened left ventricular contractility (decreased ejection fraction) and therefore intraventricular thrombi first occurred, resulting in cerebral embolization (Cases 1 and 3);[ 15 ] (3) severe hypotension due to AMI caused cerebrovascular hypoperfusion, leading to cerebral infarction;[ 3 ] and (4) an adrenergic or catecholamine surge associated with AIS-induced cardiac shock or Takotsubo syndrome. [ 5 , 14 ] Cases 4 and 5 had no obvious causes including findings suggestive of atherosclerosis, and thus, an embolic mechanism was suspected. [ 7 , 8 ] The diagnostic problem with CCI is that patients may not complain of chest pain due to impaired consciousness and/or aphasia caused by AIS: only two patients (Cases 1 and 6) complained of chest pain,[ 2 , 15 ] while in other patients including the present case, AMI was diagnosed based on a routine 12-lead ECG on admission.…”

Diagnostic values of different ECG durations in paroxysmal AF diagnosis

“…It is evident from the numbers of patients included in this study that the number of positive cases increases with detection time. Some studies show (Katsuki and Katsuki, 2019; Ramírez et al., 2019; Yanagisawa et al., 2020) that paroxysmal AF incidence is higher at night than in the daytime. Furthermore, the duration of the disease is longer.…”