A RARE CASE OF ACUTE CORONARY SYNDROME IN A YOUNG FEMALE

Abstract

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Antiphospholipid syndrome (APS) is associated with venous and arterial thrombosis. Deep vein thrombosis (DVT) and pulmonary embolism are the two most common manifestations of APS; one third of patients present with a DVT when diagnosed with APS. However, cardiac manifestations related to APS are rare. This is an interesting case of a young female that presented for cough and shortness breath who had an acute myocardial infarction (MI) that was potentially due to APS. CASE PRESENTATION: A 22 year old female with ulcerative colitis (UC) presented to the hospital with a cough and shortness of breath. She was tachycardic, tachypneic, febrile and was found to have community acquired pneumonia and was influenza B positive. After admission, her oxygen requirements continued to increase with persistent tachypnea, tachycardia and remained febrile. She was then transferred to the intensive care unit due to her respiratory status. Shortly upon arrival, she developed left sided chest and arm pain. An electrocardiogram revealed an inferior ST-elevation MI. She went emergently for a cardiac catherization and a 100% occlusion in the distal right coronary artery was found. The thrombus was then removed with aspiration thrombectomy and a balloon angioplasty was done. Dual antiplatelet therapy was then initiated. A transthoracic electrocardiogram with a bubble study was done which revealed an ejection fraction (EF) of 35%, no patent foramen ovale (PFO), and a negative bubble study. This was further evaluated with a transesophageal echocardiogram (TEE) that revealed an improvement of EF of 45% with a small PFO. The PFO was not clinically significant as during the TEE as the bubble study was also negative. A hypercoagulable work up then revealed positive anti-cardiolipin antibodies, anti-cardiolipin IgM of 15.7 (ref: <12.5 MPL units) and anti-cardiolipin IgG of 26.0 (ref: <15 MPL units). She was discharged with clopidogrel and warfarin for her MI and potential APS with plans to repeat testing once off anticoagulation. DISCUSSION: APS rarely presents with an acute MI like in this case. There have been a few cases reported in young adults that were found to have an MI secondary to APS, however those patients had no other identifiable causes. This patient also has a history of UC and there have also been a few case reports of patients with IBD presenting with an acute MI but it was very rare. While it is hard to say which one caused the MI, she did have two potential triggers (potential APS and history of UC) that may have caused this episode. In the upcoming months, she is to have repeat lab testing off anticoagulation to confirm the diagnosis of APS. CONCLUSIONS: A hypercoagulable work up should be considered in a young adult that develops a MI with no identifiable causes Reference #1: Chaturvedi S, McCrae KR. The antiphospholipid syndrome: still an enigma. Hematology Am Soc Hematol Educ Program. 2015;2015:53–60. DISCLOSURES: No relevant relationships by Nizar Al-Salameh, source=Web Response No relevant relationships by David DeCoskey, source=Web Response No relevant relationships by Alejandra Garcia Fernandez, source=Web Response No relevant relationships by SANDY GREEN, source=Web Response