Extensive Biventricular Subendocardial Infarction with Cardiogenic Shock as Secondary Brain Hit in an Asphyxiated...

Background: Acute myocardial infarction (MI) is an uncommon finding in the neonatal period, as well as in cases of hypoxic-ischemic encephalopathy (HIE). Case report: We report the case of a full-term newborn with HIE who developed extensive myocardial infarction secondary to perinatal asphyxia, accompanied by progressive neurological deterioration. Despite early initiation of therapeutic hypothermia (TH) and intensive supportive care, the infant developed refractory cardiogenic shock, rapid neurological decline, and died within the first hours of life. Postmortem examination revealed widespread subendocardial infarction affecting both ventricles, with structurally normal heart and coronary arteries. Conclusions: This case underscores the critical role of cardiovascular dysfunction in the pathogenesis of brain injury in neonates with HIE. Early interpretation of multimodal monitoring and timely detection and management of myocardial dysfunction may be essential to reduce secondary brain injury and improve outcomes in this high-risk population.