Can AMI cause acute CVA? or seizure?

[Wildschmidt]

So during school I've been working as an EMT, and I'm super confused about a patient I just saw. Here's the scoop:

* family witnessed a sudden "fit" - briefly unresponsive, snoring, drooling, incontinent followed by "jerking motions" with arms for a couple seconds

* on arrival he's A+O to everything but events, neuro all checks out (grip strength, pupils, droop, speech)

* pt's c/c is "tight" chest, substernal and left with SOB, low exercise tolerance and nausea - This has been going on for 3 days.

* pt is also dehydrated ("about 1 cup over a couple days" and slow IV flash)

* O2 15 L is maintaining sats at 100% (they dropped below 95 within a minute so we put him back on...)

* BGL 125, all other vitals normal/stable, lungs clear and equal

* ECG (we only have lead II) shows large Q's (1/3 of R), every T is inverted, and a few PJCs and PVCs

* med control advised O2, IV fluid (no change with 800 mL), nitro (no improvement) and no aspirin

Help! I'm running calls to learn but now I'm just super confused. It seems to me, he's been having an AMI for a few days (or possible PE since he was traveling) but then presented with a stroke and maybe a small seizure thrown in. We took him to a specialty center where we can't really follow up specifically.

SO...any insight? I'm humbled by this patient and appreciate any clues/tips! Thanks!

[BluegrassRN]

MIs can look like a seizure, particularly if there are other issues going on (as there so often are). If his electrolytes are horribly imbalanced (and if he's that dehydrated, they probably are), it will exacerbate the appearance.

On an anecdotal note, my grandfather was having what appeared to be seizures. He turned out to be in acute renal failure, exacerbating his CHF, with a potassium level in the 7s. They hooked him up to the monitor, caught a "seizure" while monitoring, and his seizure was actually a 30 second run of vtach.

[Wildschmidt]

Thanks for the info!

Do you mean the "seizure" activity that the family noticed was just an electrolyte issue in the muscles, or that the electrolytes can cause actual seizure EEGs?

It makes me wonder if the "stroke" the family witnessed was actually a non-perfusing rhythm... He was in the middle of nowhere, so it was 30 min before first responders got vitals on him and 45 before we got there and looked at a 3-lead.

[Lunah, MSN, RN]

Where are you getting "stroke" in any of the symptoms?

My guess is that he had an episode of v-tach or v-fib. Either can look like a seizure, if you don't have a patient hooked up to a monitor to see that it's a potentially lethal cardiac issue at work.

[mjjlRN]

I agree with above posts. Also to say, a stroke/cva is possible in conjuction with an ami. Most AMIs are caused when a severe coronary artery blockage becomes complete, usually d/t a microclot/platelet aggregation in the blockage. If this clot is dislodged, it can travel to the brain, thus causing an iscemic episode. Whether or not this happened in this case, I don't know.

[casi, ASN, RN]

I know that sometimes vfib can look like a seizure. I went running for a patient room as they went into vfib and the nursing in the room hit the call light because she thought the patient was about to have a seizure. Oddly enough the patient came out of vfib on their own.

[aCRNAhopeful]

Yeah the neuro symptoms sound like they are related to an arrythmia of some kind. It makes sense if you think about it. Say he went into a non-perfusing v-tach, vfib, or some kind of bradyarrythmia with profound hypotension: the brain is going to be underperfused. What happens if you lose perfusion to a part of the heart? It gets irritable and can suddenly go into a wild rhythm like vfib. The same thing can happen to the brain if it gets underperfused. Both organs work via an electrical system and both electrical systems need an O2 supply or they can go nuts causing a seizure or an arrythmia.

[Wildschmidt]

Thank you all for the input!

I definitely would believe that the neuro symptoms were secondary to the heart arrhythmia. The reason we thought stroke initially was because his wife was a nurse and that's what she called it in as. She described it as a sudden onset, collapse, drooling, etc, and of course we tend to trust nurses... That said, the neuro stuff improved so quickly (30-45 min) it must have been secondary to something else or a massive TIA.

It seems he's lucky to be alive - AMI going on for multiple days leading to a non-perfusing rhythm which resolved itself within a minute. He was far enough out in the middle of nowhere that we couldn't have converted him if it didn't happen on its own.