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Acute Spontaneous Coronary Artery Thrombosis as Initial Presentation of HIV Infection in a Young Man

James Kayima1, Wilson Nyakoojo2, Damalie Nakanjako3

  • 1Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda ; Uganda Heart Institute, Ward 1C, Mulago Hospital Complex, P.O. Box 7051, Kampala, Uganda.

Case Reports in Cardiology
|March 31, 2015
PubMed

Insights

Human immunodeficiency virus (HIV) infection can cause unusual acute coronary syndrome (ACS) presentations like spontaneous coronary artery thrombosis in young adults. This case highlights diagnostic and treatment challenges in HIV-positive individuals without traditional risk factors.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Vascular Biology

Background:

  • Acute coronary syndrome (ACS) in young patients, particularly those with HIV, can present atypically.
  • Spontaneous coronary artery thrombosis in HIV-positive individuals without traditional risk factors poses diagnostic and therapeutic challenges.

Purpose of the Study:

  • To report a case of spontaneous coronary artery thrombosis in a young HIV-infected patient.
  • To discuss the potential etiological role of HIV in coronary artery thrombosis.
  • To highlight challenges in percutaneous coronary intervention (PCI) for such cases.

Main Methods:

  • Case report of a 33-year-old African man presenting with acute chest pain.
  • Diagnostic workup including coronary angiography.
  • Percutaneous coronary intervention (PCI) performed for extensive coronary thrombus.

Main Results:

  • Coronary angiography revealed extensive thrombus in the left anterior descending artery without atherosclerosis.
  • PCI was complicated by plaque/thrombus prolapse.
  • Chest pain and ST-segment elevation resolved post-procedure.
  • HIV infection was diagnosed during the workup.

Conclusions:

  • HIV infection should be considered in young patients presenting with spontaneous coronary artery thrombosis, especially without traditional risk factors.
  • PCI in these patients may involve complications like atherothrombotic events.
  • Chronic inflammation and immune activation in HIV may lead to endothelial dysfunction, contributing to thrombosis.

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