Concurrent Acute Ischemic Stroke and Acute Myocardial Infarction in a Patient with Hypertrophic Cardiomyopathy: A Multisystem Emergency

Background: The combination of ischemic stroke and myocardial infarction (MI) in patients with hypertrophic cardiomyopathy (HCM) is unusual and creates diagnostic and treatment difficulties.1,2 Case summary: We describe a 53-year-old woman, who was admitted with acute ischemic stroke, and later developed a non-ST elevation MI, followed by stent thrombosis and acute transmural MI. Echocardiography revealed left ventricular hypertrophy (LVH) with systolic anterior motion (SAM) of the mitral valve and dynamic outflow obstruction, consistent with HCM. Coronary angiography revealed significant Left Anterior Descending (LAD) stenosis, treated with a drug-eluting stent (DES). Recurrent thrombosis of this stent led to transmural MI and unstable hemodynamics, requiring urgent re-intervention. Conclusion: In this patient, HCM-related outflow obstruction and structural changes contributed to both cerebral and myocardial ischemia. Balancing anticoagulation and antiplatelet therapy were particularly difficult. Early recognition of underlying HCM and close coordination between cardiology and neurology teams were essential.