On September 13, Dr. Le Duy Lac, a Level II specialist and Head of the Interventional Cardiology Unit at the Department of Cardiovascular Intensive Care, Thu Duc General Hospital (Ho Chi Minh City), shared details of what he described as a “bizarre” clinical case.

The patient, who had a history of hypertension, was admitted to the hospital with impaired consciousness and right-side weakness. MRI results confirmed an acute cerebral hemorrhagic stroke.

One hour after admission, the patient suddenly broke out in a sweat, experienced a drop in blood pressure, slowed heart rate, and shortness of breath. An ECG revealed ST-segment elevation myocardial infarction (STEMI) combined with a third-degree atrioventricular block.

According to Dr. Lac, this rare and life-threatening scenario poses a major treatment dilemma. The two conditions require completely opposite treatment approaches: myocardial infarction demands urgent coronary revascularization using anticoagulants and antiplatelet drugs, while those same medications are strictly contraindicated for cerebral hemorrhage, as they could worsen the bleeding. Currently, there are no globally accepted treatment guidelines for such dual-pathology cases.

“Managing this case was like walking a tightrope. Lean too far to either side and the outcome could be fatal. Extreme caution and multidisciplinary coordination were essential,” Dr. Lac said.

Faced with a critical and complex situation, the cardiology and neurology teams opted for a coronary intervention that would “buy time.” They performed balloon angioplasty and thrombus aspiration to restore blood flow without placing a stent and without using anticoagulant therapy. This minimized the risk of exacerbating the brain hemorrhage while still addressing the cardiac emergency.

After three days, once the patient's neurological condition had stabilized, a second MRI confirmed improvement. At that point, the medical team safely placed a coronary stent, using intravascular ultrasound to guide the procedure and ensure optimal blood flow while still minimizing the risk of further brain bleeding.

Dr. Lac documented the case in a report, which has since been published in the European Heart Journal - Case Reports, a publication of the European Society of Cardiology (ESC). The article underwent an eight-month peer review process by international experts before being accepted. It is now indexed in PubMed, the medical database of the U.S. National Institutes of Health (NIH), making it accessible to clinicians and researchers worldwide.

Dr. Vu Tri Thanh, MD, PhD, a Level II specialist and Director of Thu Duc General Hospital, served as the lead mentor on the study. He highlighted the treatment strategy as an effective way to manage patients with simultaneous myocardial infarction and cerebral hemorrhage, balancing the risks of thrombosis and bleeding.

Dr. Thanh also emphasized that scientific research is one of seven core missions at the hospital, alongside clinical care, education, inter-hospital collaboration, disease prevention and health education, international cooperation, and healthcare management.

The success of this case not only contributes to the medical literature but also provides a valuable reference for similar complex scenarios worldwide, now easily accessible via PubMed.

Phuong Thuy