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Non-ST elevation myocardial infarction with multivessel disease and anoxic brain injury: a case report
Hayden Moses1, Abbas Mohammadi1, Talha Naser Jilani1
1Department of Internal Medicine, Valley Health System Graduate Medical Education, Las Vegas, NV, USA.
Insights
This case study details a patient with severe coronary artery disease (CAD) who experienced a hypoxic event leading to anoxic brain injury and herniation. It underscores the risks associated with complex cardiovascular interventions in high-risk individuals.
Area of Science:
- Cardiology
- Neurology
- Oncology
Background:
- A 71-year-old male with multiple comorbidities including hypertension, dyslipidemia, type 2 diabetes, prior bladder cancer, transient ischemic attacks, and coronary artery disease (CAD) presented with chest pain.
- The patient's history indicated significant cardiovascular and oncological risk factors.
Purpose of the Study:
- To illustrate the challenges in managing severe coronary artery disease (CAD) in a patient with extensive comorbidities.
- To highlight the potential for severe neurological complications following cardiac procedures in high-risk populations.
Main Methods:
- Clinical presentation of substernal chest pain, shortness of breath, and nausea.
- Diagnostic workup including elevated troponins, non-specific ECG changes, and coronary angiography revealing severe multivessel disease and left main stenosis.
- Post-procedural management of anoxic brain injury, acute hydrocephalus, and transtentorial herniation.
Main Results:
- Coronary angiography confirmed severe multivessel disease, including critical left main stenosis.
- The patient developed anoxic brain injury and acute hydrocephalus post-procedure, leading to transtentorial herniation.
- Despite aggressive medical interventions, progressive neurological decline occurred, leading to palliative care consultation.
Conclusions:
- Managing severe CAD in patients with multiple comorbidities presents significant complexities and risks.
- Peri-procedural complications, such as hypoxic events, can lead to devastating neurological outcomes.
- This case emphasizes the critical need for careful risk assessment and management strategies in high-risk cardiovascular patients.
Abstract:
A 71-year-old black male with a history of hypertension, dyslipidemia, type 2 diabetes, history of bladder cancer status-post resection now in remission, history of multiple transient ischemic attacks, and coronary artery disease (CAD) presented with non-exertional substernal chest pain radiating to the left arm, accompanied by shortness of breath and nausea. Initial evaluation revealed elevated troponins and nonspecific electrocardiogram changes, consistent with non-ST elevation myocardial infarction. Coronary angiography demonstrated severe multivessel disease, including critical left main stenosis. Post-procedurally, the patient developed anoxic brain injury, likely due to a hypoxic event, leading to acute hydrocephalus and transtentorial herniation. Despite aggressive management, the patient experienced progressive neurologic decline, necessitating palliative care consultation. This case highlights the complexities of managing severe CAD in high-risk patients and the devastating consequences of peri-procedural complications.
