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Stroke and ST Elevation

A 77-year-old man was brought to the Emergency Department with stroke symptoms.  He had less than one hour since symptom onset.  He presented with extreme weakness of his right side and slurred speech.   He has a history of coronary artery disease and previous acute M.I.  His BP was 188/80, P 46/min., and resp. 16/min.  He denies chest pain, N&V, and shortness of breath.  The E.D. physician called in the stroke team, and a diagnosis of CVA was made.   What does his ECG show?

This ECG shows clear ST elevations in V1 and V2, with abnormally flat ST segments in nearly all leads.  In addition, there are ischemic T wave inversions in Leads V3, V4, V5, I, and aVL.   A diagnosis of anterio-lateral M.I. is made in addition to stroke.

Ischemic changes, like ST elevation and T wave inversions have been demonstrated frequently in patients with strokes.  Stroke symptoms have also been recorded in patients who are having M.I.s.  Ischemic stroke has been shown to be a complication of acute myocardial infarction.  Hemorrhagic stroke can follow anticoagulation or thrombolysis.   Also, acute M.I. has been shown to be a complication of stroke. Artery disease is a common denominator in both conditions. 

Needless to say, this can be a very complex problem, and the patient with stroke symptoms requires a CT scan to rule out hemorrhage before the M.I. is treated with anticoagulants or thrombolytics. 

References:  MI After Stroke, The Heart.orgIncidence of Stroke After Acute M.I., Witt, et al ; Ischemic Stroke After Acute Myocardial Infarction, Mooe, et al.



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