Double-edged sword for management of acute coronary syndrome coincides with an

acute cerebrovascular incident: cardio-cerebral infarction syndrome.

N.N. Triatmojo1,2, L.H. Zunardi1,2, S. Anjarwani1,2, I.Prasetya1,2,
1. Brawijaya Cardiovascular Research Center, Department of Cardiology and
Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Malang,
Indonesia.
2. Department of Cardiology and Vascular Medicine, dr. Saiful Anwar General
Hospital, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia.

Background: Acute ST-elevation Myocardial Infarction (STEMI) and acute Cerebrovascular

Accident (CVA) are both very serious medical conditions that can be life-threatening if they
are not handled right away. A very small chance of 0.009% for this event to happen at the
same time has been recorded. There is a lot of information in the literature and standards
about how to treat each illness separately. However, when both illnesses happen at the same
time, it makes therapy more difficult. Because of the higher chance of making the bleed
worse, the standard treatment for STEMI (revascularization and antithrombotic therapy)
shouldn't be used on people with CVA especially CVA haemorrhage. There is a chance that
directly treating one illness could make it harder to treat the other or even be damaging.

Case Report: An abrupt obstruction of blood flow due to STEMI inferior and RV infarction
was encountered by a 70-year-old male. Less than a week ago, he had an acute CVA with an
aphasic presentation. It is very important to determine whether the CVA is an infarction or a
haemorrhage, because it will influence the decision to use anti-platelets and anti-coagulants.
Because this illness is so rare, no treatment techniques were suggested. After ensuring the
patient did not experience CVA haemorrhage using a CT scan, he was given a loading dose of
DAPT, an intravenous anticoagulant, and then underwent primary PCI. Following an acute
cardio-cerebral infarction, utilizing the PCI method for mechanical reperfusion may be the
optimal approach to restoring normal blood flow. The patient's chest pain was relieved, and
there was no worsening of CVA symptoms after treatment.

Conclusion: The occurrence of both STEMI and CVA at the same time is uncommon, but
when these two prevalent disorders do occur together, it poses a distinct therapeutic difficulty.
it is essential to carefully assess the patient's condition, weigh the risks and benefits of different
treatment options, and tailor the treatment plan to the patient's requirements. PCI should be reasonable
approach in treating patients with simultaneous cardio cerebral infarction Despite being rare,
this demanding situation warrants greater acknowledgment and deliberation among the
medical professional.
Key Word: Cardio Cerebral Infarction, Acute coronary syndrome, cerebrovascular accident