Abstract
Acute myocardial infarction (AMI) is rarely associated with antiphospholipid syndrome. The treatment of these patients is a clinical challenge. We report the observations of 2 young adults (1 woman and 1 man), admitted in our acute care unit for acute myocardial infarction (AMI). A coagulopathy work-up concludes the existence of antiphospholipid syndrome (APS) in the 2 cases. APS syndrome was considered primary in 2 cases. All patients presented an intense inflammatory syndrome (high level of CRP). Anticardiolipine was present in the 2 cases. However, anti B2 glycoprotein I antibodies were detected in only one case. Emergency percutaneous transluminal coronary angioplasty (PTCA) with direct stenting had been performed successfully only in the first case, and the follow-up was uncomplicated. Thereafter, long-term oral anticoagulant appeared to be effective. The last patient was admitted because of peripheral acute ischemia of legs. Standard electrocardiogram showed signs of previous silent anteroseptal wall myocardial infarction confirmed by echocardiography. The latter revealed an apical thrombus and a very low left ventricular ejection fraction. Amputation of the right leg was necessary because of consultation occurred too late. However, he died four weeks later. Primary antiphospholipid syndrome should be considered as a cause of acute myocardial infarction in young adults, and PTCA with anticoagulant treatment is effective for initial treatment of this complication.
Highlights
Antiphospholipid syndrome (APS) is an autoimmune disorder of acquired hypercoagulability characterized by the association of vascular thromboses and or pregnancy morbidity and persistent elevated serum levels of Antiphospholipid antibodies [1] It is considered as a multisystemic disorder with a wide spectrum of presentations cutting across all subspecialties of medicine
Acute myocardial infarction is unusual in young adults, but it has been reported in patients with antiphospholipid syndrome
Acute myocardial infarction is unusual in young adults; antiphospholipid syndrome may be one of the aetiologies
Summary
Antiphospholipid syndrome (APS) is an autoimmune disorder of acquired hypercoagulability characterized by the association of vascular thromboses (venous, arterial, small vessels) and or pregnancy morbidity (foetal loss, premature birth or recurrent embryonic losses) and persistent elevated serum levels of Antiphospholipid antibodies (anticardiolipin, lupus anticoagulant or anti- B2glycoprotein I) [1] It is considered as a multisystemic disorder with a wide spectrum of presentations cutting across all subspecialties of medicine. A 30 years old woman with a history of recurrent spontaneous abortion was admitted with severe midsternal chest pain, associated with sweating, nausea, and breathlessness She had no risk factors for atherosclerosis (diabetes mellitus, hyperlipidaemia, hypertension, and smoking). Antiphospholipid antibodies tests repeated 12 weeks later remained positive These findings satisfy the update Sapporo Classification criteria [1] for the diagnosis of antiphospholipid syndrome. Echocardiography revealed an apical large thrombus measuring 38 by 18 mm associated with a thinning left ventricular wall, suggesting painless myocardial infarction. It demonstrated a markedly reduced left ventricular ejection fraction (19%) (Figure 3). The patient died 15 days after his admission because of the failure of many of his organs (heart failure, acute renal failure, cytopenia)
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