Unexplained acute coronary occlusion causing anterior myocardial infarction

Area of Science:

• Cardiology
• Cardiovascular Pathology
• Oncology

Background:

• Acute myocardial infarction (AMI) in young adults is uncommon.
• Cardiogenic shock secondary to left main stem (LMS) occlusion presents a critical emergency.
• Left main stem (LMS) disease can be caused by various pathologies, including rare tumors.

Observation:

• A young woman presented with AMI and cardiogenic shock.
• Coronary angiography revealed an occluded left main stem (LMS), requiring stenting due to re-occlusions.
• Imaging identified a mass in the left aortic sinus, consistent with a papillary fibroelastoma.

Findings:

• Papillary fibroelastoma of the left aortic sinus causing left main stem (LMS) occlusion.
• Despite diagnosis and interventions, the patient's condition deteriorated.
• The mass was not identified during surgical exploration.

Implications:

• Papillary fibroelastomas, though rare, can precipitate life-threatening cardiac events like AMI.
• Diagnostic challenges exist in identifying cardiac masses, especially when they cause dynamic coronary occlusion.
• This case highlights the critical need for comprehensive diagnostic workups in young patients with severe coronary events.