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A 42-year-old man with recurrent myocardial infarction and normal appearing coronary arteries

H D Danenberg1, Y Hasin, D Gilon

  • 1Department of Cardiology, Hadassah University Hospital, Jerusalem, Israel. danen@md2.huji.ac.il

International Journal of Cardiology
|November 5, 1999
PubMed

Insights

A coronary mural thrombus caused recurrent myocardial infarction despite normal epicardial arteries. This highlights the need for ongoing anti-platelet and vasodilator therapy in small-vessel coronary artery disease.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Pathology

Background:

  • Small-vessel coronary artery disease (CAD) presents diagnostic challenges.
  • Epicardial coronary arteries may appear normal despite significant myocardial ischemia.
  • Coronary mural thrombus formation is a rare complication.

Observation:

  • A patient presented with recurrent myocardial infarction.
  • Diagnostic angiography revealed normal-appearing epicardial coronary arteries.
  • Evidence of small-vessel coronary artery disease was identified.

Findings:

  • A coronary mural thrombus was detected.
  • The thrombus was associated with recurrent myocardial infarction in the context of normal epicardial arteries.
  • Small-vessel CAD was the underlying pathology.

Implications:

  • This case underscores the critical role of medical management in small-vessel CAD.
  • Permanent anti-platelet and vasodilator therapy is crucial for preventing recurrent events.
  • Accurate diagnosis and treatment of small-vessel disease are essential for patient outcomes.

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