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Unexplained acute coronary occlusion causing anterior myocardial infarction
Daniel C S Chan1, Andrew D'Silva2, Konrad Grosser2
1Department of Cardiology , Kettering General Hospital , Kettering NN16 8UZ , UK.
Oxford Medical Case Reports
|May 20, 2015
Summary
A young woman experienced acute myocardial infarction due to left main stem occlusion, later diagnosed as a papillary fibroelastoma. Despite interventions, she died awaiting a heart transplant, with the mass never located during surgery.
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.
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