Simultaneous Presentation of Stroke and ST-Elevation Myocardial Infarction: Interdisciplinary Challenges in Emergency Care

Introduction Debate continues over whether post-stroke cardiac dysfunction stems from pre-existing vascular comorbidity, is stroke-induced, or from both. 10–20% of acute stroke patients experiencing severe cardiac events, even without prior heart disease. We present a clinical case where stroke and cardiac pathology were diagnosed simultaneously Method Chart review of the digital patient records [ 1 ] [ 2 ]. Results CASE DESCRIPTION: A 74-year-old woman was admitted to the ICU in August 2024 with ST-segment elevations in leads II, III, and aVF within the thrombolysis window from Emergency room. She was conscious, oriented, and pain-free. She experienced before the event head pressure, headache, dizziness, balance loss, inability to stand, and dyspnoea during yoga exercises. Her history includes hypertension, dyslipidaemia, mixed-type asthma, anxiety disorder and sleep apnoea. Medicines: Perindoprilum, Amlodipinum, Indapamidum, Rosuvastatin and Metoprolol. Since the patient’s medical history and the ECG findings were inconsistent, in ICU a CT scan of the brain before routine thrombolysis was performed, as the symptoms and the patient’s complaints suggested a neurological pathology. Fig. 1 ECG in the Emergency Room 10.08 CT : Occlusion of the distal vertebral arteries and the origin of the basilar artery. Approximately 50% stenosis of the left internal carotid artery. Neurologists joint opinion : Occlusion of the distal segments of the vertebral arteries has not, at this point, resulted in neurological symptomatology. The patient shows no signs of acute cerebral infarction, NIHSS 0. Multidisciplinary consultation (neurologist, internal medicin, radiologist and anesthesiologist) first found no contraindications for thrombolysis. Concerns: efficacy of thrombolysis on potentially chronic cerebral thrombi and the risk of intracerebral haemorrhage. which protocol should be applied for thrombolysis — the cardiac protocol or the cerebral protocol. Consultation with the tertiary hospital cardiologist, the decision was made to omit thrombolysis and patient was transferred for cardiological intervention. Patient underwent PCI for distal RCA occlusion; LAD pre-occlusion with collaterals was also noted. The procedure was complicated by hypotension, loss of consciousness, and brief AV block. Subsequently, the patient developed altered mental status and dysarthric speech. 11.08MRI revealed acute ischaemic lesions in multiple vascular territories, suggesting embolic stroke (NIHSS 4). Initial rehabilitation showed truncal ataxia and broad-based gait with high-frame assistance. By discharge, mobility improved, though supervision remained essential. Conclusion Although insights into pathogenesis may provide answers in the future, during emergencies, viewing pathologies as separate entities can hinder effective decision-making. Acute myocardial infarction and acute ischaemic stroke are both critical emergencies, and their coexistence markedly worsens prognosis. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany