The article describes the case of a 65-year-old woman admitted with an acute heart attack in the left basal ganglia and periventricular. She had comorbid stage IV diabetic kidney disease and renal anemia. After the stroke, her NT-proBNP level remained persistently elevated above 20,000 pg/mL, although she was clinically stable with normal cardiac structure and function on echocardiography. They interpreted this as a depletion of cardiovascular reserves and implemented an individual rehabilitation strategy of "cautious initiation and gradual progression". The multidisciplinary team optimized volume status, corrected anemia and monitored a gradual rehabilitation protocol. The patient successfully completed rehabilitation without cardiovascular complications and demonstrated neurological improvement. The conclusion emphasizes that in complex comorbidities, high NT-proBNP may signal reserve depletion, not necessarily heart failure, and individualized early rehabilitation is safe provided careful management.