PP-027: ACUTE MYOCARDIAL INFARCTION DUE TO LOW VITAMIN B12 LEVEL INDUCED HYPERHOMOCYSTEINEMIA IN A YOUNG WOMAN

Abstract

of acute myocardial infarction, ventricular septal rupture (VSR) is the most serious, together with rupture of the ventricular free wall and/or papillary muscle. To the best of our knowledge, this is) the first case of VSR secondary to coronary artery embolism. Methods: A 70 year-old female was admitted to the emergency department with the compliant of chest pain lasting for two days. Her medical story was remarcable for hypertension. Her initial electrocardiogram revealed atrial fibrillation with ventricular rate of 106 beats per minute and 2–3mm ST elevation, Q waves, T wave inversion in lead V2-V6. Her blood presure was 90/60mmHg. In physical examination: tachycardia, and apical 2/6 degree sistolic murmur were noted. Her fasting blood glucose, serum creatinin and troponin I values were 114mg/dl, 1.41mg/dl, 9.3ng/ml respectively. Transthoracic echocardiography revealed left ventricular systolic disfunction, aneurysm in the mid-apical inferoseptal wall and ventricular septal rupture. EF was 40% (figure). The diagnosis was subacut anterior myocardial infarction, ventricular septal rupture. Coronary angiography showed normal coronary arteries. An intraaortic balloon counterpulsation catheter was placed. The patient was given emergency surgery by consultation with cardiovascular surgeons. About 1.5 cm wide VSR was seen on apical part of interventricular septum in surgery and primary sutured. After operation during her manegement in intensive care unit the patient developed acute kidney failure and she died due to (deep) acidosis in second day of her operation. Conclusions: Coronary artery embolism is a rare cause of acute myocardial infarction and the precise diagnosis remains challenging for the cardiologists. The prevalence of this nonatherosclerotic entity remains unknown because of its difficulties on diagnosis in the acute setting. In general, 4 to 7% of all patients diagnosed with an AMI do not have atherosclerotic coronary disease at autopsy or coronary angiography. VSR after MI is rare but a very mortal complication. In this situation the diagnosis should be done quickly and surgery should perform in early period. Although, Acute MI due to coronary embolus secondary to AF was reported in literature before, according to our knowledge, this is the first case with complicated VSR.