Abstract
Introduction. The presentation of acute coronary syndrome (ACS) in young HIV patients may be atypical with different pathophysiological and clinical features. Acute coronary thrombosis, as a presentation of acute coronary syndrome in young patients with HIV, raises diagnostic and treatment challenges. Case Presentation. We describe a case of a 33-year-old African man, without traditional atherosclerotic risk factors, who presented with chest pain of acute onset. Emergent coronary angiography revealed extensive thrombus in the left anterior descending coronary artery with no evidence of atherosclerosis in this or other coronary vessels. Plaque and/or thrombus prolapse through the stent was noted following percutaneous coronary intervention (PCI). Resolution of chest pain and improvement in ST-segment elevation was noted after the procedure. A diagnosis of HIV infection was made during the workup for HIV infection. Conclusion. In young patients without traditional risk factors, HIV infection is a possible etiological factor for spontaneous coronary artery thrombosis. Percutaneous coronary intervention in patients with this presentation may be compounded with atherothrombotic complications. The likely pathophysiological pathway is superficial endothelial cell denudation as a result of chronic inflammation and immune activation.
Highlights
The presentation of acute coronary syndrome (ACS) in young HIV patients may be atypical with different pathophysiological and clinical features
An increased prevalence of traditional risk factors, uncontrolled viral replication, and metabolic toxicities of antiretroviral therapy (ART) have been proposed as underlying drivers of atherosclerosis and risk for ACS [1], yet few studies have been conducted in sub-Saharan Africa [2]
This case illustrates an ACS caused by spontaneous left anterior descending (LAD) thrombosis in a patient with HIV infection
Summary
An increased risk of myocardial infarction has been documented in HIV-infected patients since the advent of efficacious antiretroviral therapy (ART) that prolongs life. Spontaneous coronary thrombosis in young HIV individuals has been described in patients on antiretroviral therapy [3, 4]. We report a somewhat rare case of a 33-year-old man with previously undiagnosed HIV-infection who emergently presented with an anteroseptal ST-segment-elevation myocardial infarction (STEMI). Coronary angiograms revealed extensive thrombus in the left anterior descending artery with minimal angiographic coronary artery disease and no spontaneous coronary artery dissection. This presentation may pose challenges in management
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