Recurrent ST Elevation Myocardial Infarction: What is the Aetiology?

Area of Science:

• Cardiology
• Rheumatology
• Immunology

Background:

• Coronary artery disease (CAD) is a major cause of death globally, often due to atherosclerotic plaque rupture.
• ST-elevation myocardial infarction (STEMI) typically results from acute coronary plaque events.
• Uncommon etiologies of STEMI, like vasculitis, are often overlooked by clinicians.

Observation:

• A female patient presented with recurrent STEMI on three separate occasions within five days.
• The recurrent STEMI events were linked to an underlying diagnosis of granulomatosis with polyangiitis (GPA).
• GPA, a form of systemic vasculitis, affected the coronary arteries.

Findings:

• Granulomatosis with polyangiitis (GPA) can manifest as ST-elevation myocardial infarction (STEMI).
• This case demonstrates a rare but critical presentation of vasculitis mimicking typical acute coronary syndromes.
• Early recognition of vasculitis is crucial for appropriate STEMI management.

Implications:

• Clinicians should consider vasculitis in the differential diagnosis of recurrent or atypical STEMI.
• Prompt diagnosis and treatment of GPA can prevent further cardiac events and improve patient outcomes.
• Raising awareness of vasculitis as a cause of STEMI is essential for the cardiology community.