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A Case of ST-elevated myocardial infarction resulting from obstructive intramural coronary amyloidosis

Katsura Soma1, Masataka Takizawa, Hiroki Uozumi

  • 1Department of Cardiovascular Medicine, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan.

International Heart Journal
|April 10, 2010
PubMed

Insights

Early cardiac amyloidosis can cause acute coronary syndrome by affecting small coronary arteries, even without significant blockages in larger ones. This condition, AL amyloidosis, highlights the need to consider cardiac amyloidosis in acute myocardial infarction cases.

Area of Science:

  • Cardiology
  • Nephrology
  • Hematology

Background:

  • Acute coronary syndrome (ACS) is a leading cause of mortality worldwide.
  • AL amyloidosis is a systemic disease caused by immunoglobulin light chain deposition.
  • Cardiac involvement in AL amyloidosis can lead to various cardiovascular complications.

Observation:

  • A 49-year-old man presented with ST-elevated myocardial infarction (STEMI) and diagnosed AL amyloidosis.
  • Coronary angiography revealed normal epicardial arteries but abnormal responses to acetylcholine and papaverine, indicating endothelial dysfunction.
  • Myocardial biopsy confirmed amyloid deposition solely within the intramural coronary arteries.

Findings:

  • Early-stage cardiac amyloidosis, even without significant myocardial infiltration, can precipitate ACS.
  • The mechanism involves a combination of epicardial coronary artery spasm and intramural coronary artery obstruction due to amyloid deposits.
  • Impaired vascular endothelial function is a key contributor to the ischemic events.

Implications:

  • Cardiac amyloidosis should be considered in the differential diagnosis of ACS, particularly in patients with unexplained coronary artery abnormalities.
  • Early recognition and management of cardiac amyloidosis may improve outcomes for patients presenting with acute coronary syndromes.
  • This case highlights the importance of investigating underlying systemic diseases in patients with myocardial infarction.

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