Simultaneous Acute Ischemic Stroke and ST-Elevation Myocardial Infarction Pre-hospital Emergency Management by a General Practitioner

Abstract Simultaneous acute ischemic stroke (AIS) and ST-elevation myocardial infarction (STEMI) is a rare and life-threatening clinical scenario that presents significant management challenges, particularly in pre-hospital settings. We report the case of a 45-year-old male with a history of chronic hypertension, prior ischemic attacks, and paraplegia, who initially presented with severe hypertension. While initially without acute focal neurological deficits, he rapidly developed aphasia, upward gaze deviation (vertical nystagmus), tremor, and hemiparesis, accompanied by ST-segment elevation on electrocardiography. At the time of assessment, the patient was unconscious, rendering oral aspirin administration impossible. In the pre-hospital setting, immediate blood pressure control was initiated and intravenous unfractionated heparin was administered as a single bolus dose, avoiding continuous infusion to minimize hemorrhagic risk, in accordance with guideline-recommended management for STEMI. The patient was then urgently transferred to a tertiary center, where emergency percutaneous coronary intervention was successfully performed. The patient survived with full recovery of consciousness. This case highlights the critical role of timely clinical judgment and decisive pre-hospital management by a general practitioner in simultaneous cardio-cerebral emergencies. Written informed consent was obtained from the patient for publication of this case report.