Abstract
Coronary artery embolism is an uncommon cause of acute myocardial infarction (AMI), while antiphospholipid syndrome (APS) is one of the rare reasons due to premature AMI. Coronary angiography can diagnose coronary artery embolism, and the positive serum of aPLs may infirm APS. We report a 32 years old man with ST-elevation AMI, without any high-risk factors of coronary artery disease. Coronary thrombosis was founded in the M1 sub-coronary of Left Anterior Descending (LAD), and the coronary artery was recanalized, the artery was not obstructive, Thrombolysis in Myocardial Infarction (TIMI) grade was III. He became shortness after exercise, the echocardiography showed his left ventricular was enlarged and LVEF was decreased. High titers of an anticardiolipin antibody (aCL) IgG of 46U (positive >20.0U), and it was positive at two dosages with an interval greater than 12 weeks. But there was no evidence of any other serum markers suggesting other associated pathologies such as SLE, so the primary APS was diagnosed. We gave him anticoagulation with warfarin and a single antiplatelet with Aspirin, the target INR was 2.5-3.0. Meanwhile, statins and hydroxychloroquine (HCQ) were all prescribed. After 6-months follow-up, his heart failure symptoms were disappeared, the LVDd and LVEF were all normal, the titer was decreased to nearly normal. In clinical background, young AMI without traditional high-risk factors of CAD, we should suspect APS. Therefore, we believed that HCQ may low thrombotic rate, down-trending aPLs titer, and prevent thrombotic recurrences in patients with primary antiphospholipid syndrome.
Highlights
We report a 32 years old man with ST-elevation acute myocardial infarction (AMI), without any high-risk factors of coronary artery disease
Coronary artery embolism is an uncommon cause of acute myocardial infarction (AMI), being identified as an etiology in 3-4% of the diagnosed cases, and it is easy to be ignored in clinical practice [1]
If a young male suddenly appears as AMI, without any atherosclerotic risk factors, but with a history of one of the following: atrial fibrillation, endocarditis, valve replacement, or venous thrombosis should be suspected as coronary embolism, while antiphospholipid syndrome (APS) was an uncommon cause of coronary embolism
Summary
Coronary artery embolism is an uncommon cause of acute myocardial infarction (AMI), being identified as an etiology in 3-4% of the diagnosed cases, and it is easy to be ignored in clinical practice [1]. Its presentation is quite variable, constituting a spectrum of findings ranging from the presence of cutaneous alterations to the involvement of multiple organs, leading to systemic collapse It is associated with thrombotic events involving venous and arterial territories, large arteries and veins as well as microvascular circulation and obstetrical events, in association with persistent antiphospholipid antibodies (aPLs), one or more of lupus anticoagulant (LA), and anticardiolipin antibodies (aCL) and /or IgM anti-beta 2 glycoprotein 1(ß2GP1) [3], which are implicated in the development of endothelial dysfunction among the factors. The myocardial cells were damaged, left ventricular was enlarged and the LVEF was decreased
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