Simultaneous acute cerebral and myocardial infarction ('cardio-cerebral infarction') is extremely rare, associated with very high mortality, and requires early coronary artery evaluation even in patients with asymptomatic myocardial infarction.
Key Findings
Results
A 62-year-old man presented with simultaneous acute multiple ischemic strokes of the left cerebral hemisphere and acute anterior ST-segment elevation myocardial infarction (STEMI) without chest pain.
Chief complaints were right-sided limb weakness and inability to speak for more than 4 hours
No chest pain was reported, making the myocardial infarction clinically silent at presentation
Electrocardiographic findings were consistent with acute anterior ST-segment elevation myocardial infarction
The patient had a National Institutes of Health Stroke Scale (NIHSS) score of 13, indicating moderately severe stroke
Results
Imaging confirmed acute occlusion of the left internal carotid artery with multiple cerebral infarctions.
Computed tomography angiography revealed acute occlusion of the left internal carotid artery
Magnetic resonance imaging demonstrated multiple infarctions in the left cerebral hemisphere
The combination of vascular imaging and MRI was used to characterize the extent and location of ischemic damage
Results
Emergency thrombectomy of the left internal carotid artery resulted in good initial neurological recovery with only mild hemiplegia.
The patient underwent emergency thrombectomy of the left internal carotid artery
He recovered well after the procedure with only mild hemiplegia
He regained independence in activities of daily living following the intervention
Results
The patient died suddenly from cardiac and respiratory arrest during the stable recovery phase.
Death occurred during what was considered a stable recovery phase, not during the acute intervention period
The fatal event was sudden cardiac and respiratory arrest
This outcome illustrates the high mortality risk persisting beyond the acute treatment phase in cardio-cerebral infarction
Background
Simultaneous cardio-cerebral infarction is extremely rare, most documented cases are limited to case reports, and no specific treatment guidelines have been established.
Treatment strategies considerably vary among individuals
The prognosis is often poor, particularly in older patients
The authors note that the simultaneous occurrence of acute cerebral and myocardial infarction is 'extremely rare'
The lack of guidelines underscores the need for greater clinical awareness and further study
Conclusions
The authors conclude that early coronary artery evaluation is important even in patients with asymptomatic myocardial infarction due to the risk of cardiogenic shock.
Cardio-cerebral infarction can increase cardiogenic shock risk
The case highlights that myocardial infarction may be clinically silent in the setting of concurrent stroke
The rehabilitation phase should receive close attention with appropriate monitoring to detect potentially fatal complications
Survivors of cardio-cerebral infarction often have poor outcomes
What This Means
This case report describes a 62-year-old man who suffered two life-threatening events at the same time: a major stroke affecting the left side of his brain and a heart attack involving the front of his heart. Unusually, he had no chest pain, so the heart attack was only discovered through an electrocardiogram (ECG). Brain imaging showed a blocked artery supplying the left side of his brain and multiple areas of dead brain tissue. Doctors performed an emergency procedure to remove the blood clot from his brain artery, and he initially recovered well enough to care for himself with only mild weakness on one side of his body. However, he later died suddenly from cardiac and respiratory arrest during what appeared to be a stable recovery period.
This research suggests that when stroke and heart attack happen at the same time — a condition sometimes called 'cardio-cerebral infarction' — the risk of death remains very high even after initial treatment appears successful. The case highlights that heart attacks can occur silently alongside a stroke, meaning doctors should routinely check for heart problems in stroke patients even when there is no chest pain. The authors emphasize that close monitoring should continue well into the recovery phase, not just during the initial emergency, because fatal complications can arise unexpectedly.
Because simultaneous stroke and heart attack is so rare, there are no established treatment guidelines, and doctors must make individualized decisions. This research suggests that greater clinical awareness of this combined condition is needed to improve survival rates and outcomes, and that the rehabilitation period deserves the same level of vigilance as the acute emergency phase.
Wei X, Liu Z. (2026). Simultaneous Acute Multiple Ischemic Strokes of the Left Cerebral Hemisphere and Signs of Acute Anterior STEMI: A Case Report.. The American journal of case reports. https://doi.org/10.12659/AJCR.952855