Abstract
ST segment elevation acute myocardial infarction manifested by ischemic chest pain following heart transplantation is rare [1,2]. Acute renal failure complicating cardiogenic shock associated with this condition has never been previously reported. We report herein the efficacy of switching cyclosporine to sirolimus as part of the treatment of acute renal failure complicating cardiogenic shock due to ischemic chest pain acute myocardial infarction following hear transplantation. A 39-year-old man underwent orthotopic heart transplantation at our institution because of end-stage endomyocardial fibrosis. The perioperative period was uneventful. Immunosuppression consisted of cyclosporine (target blood levels: 250–350 ng/ml), mycophenolate mofetil (2 g daily) and prednisone (0.3 mg/kg daily). Four months later, he was admitted to the Critical Care Unit Hospital complaining of typical myocardial infarction-type chest pain, lasting more than 2 days. Physical examination showed no abnormality. A 12-lead electrocardiogram revealed new pathologic Q waves and ST segment elevation in the inferior and anterior leads. A Doppler echocardiogram revealed akinesis of the anterior, lateral and apical walls and thrombus in the apical region. Troponin plasma levels were 4.26 ng/ml (normal range:
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