Abstract
Although both coronary artery dissection and heparin-induced thrombocytopenia may provoke myocardial infarction, it is extremely rare for both conditions to develop simultaneously in a single patient. We report a case of a 69-year-old woman who sustained a head-on motor vehicle accident with associated chest trauma. During a subsequent hospitalization, she was exposed to subcutaneous heparin and developed significant thrombocytopenia. Shortly thereafter, she re-presented with an acute myocardial infarction. Coronary angiography revealed a spiral dissection with superimposed thrombosis within the right coronary artery, while laboratory testing confirmed the diagnosis of heparin induced thrombocytopenia. She was treated with catheter-based thrombectomy and adjunctive direct thrombin inhibitor therapy, followed by three months of systemic anticoagulation with warfarin. To our knowledge, this represents the first published case of a native vessel myocardial infarction due to the combination of coronary artery dissection and heparin-induced thrombocytopenia.
Highlights
Myocardial infarction typically occurs in patients with underlying atherosclerotic coronary artery disease
Coronary artery dissection most commonly affects the left anterior descending artery followed by the right coronary artery and the circumflex [4]
Following the development of Heparin-induced thrombocytopenia (HIT), there is an associated thromboembolic risk of 5–10% per day after the discontinuation of heparin; this risk of thrombosis may persist for several months after recovery of the platelet count [9]
Summary
Myocardial infarction typically occurs in patients with underlying atherosclerotic coronary artery disease. Other less common conditions may lead to myocardial infarction even in the absence of atherosclerosis, . The following case report illustrates an unusual etiologic mechanism for acute myocardial infarction, involving cardiac trauma with subsequent coronary dissection and endothelial disruption, followed by thrombosis in the context of heparin-induced thrombocytopenia
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