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Ischemic Cardiomyopathy with a Rapid Progression from Thrombotic Thrombocytopenic Purpura

Hiroaki Morinaga1, Tetsuro Miyazaki, Miyuki Tsutsui

  • 1Department of Cardiovascular Medicine, Juntendo University School of Medicine, Japan.

Internal Medicine (Tokyo, Japan)
|September 16, 2015
PubMed

Insights

Thrombotic thrombocytopenic purpura (TTP) can rapidly cause ischemic cardiomyopathy and myocardial microthrombi, leading to sudden cardiopulmonary arrest. This case highlights TTP

Area of Science:

  • Cardiology
  • Hematology
  • Pathology

Background:

  • Thrombotic thrombocytopenic purpura (TTP) is a rare hematologic disorder.
  • TTP can present with diverse clinical manifestations, including cardiac involvement.
  • Ischemic cardiomyopathy is a significant cause of heart failure.

Observation:

  • An 83-year-old woman presented with dizziness and nausea.
  • Initial investigations revealed ST-segment elevation and left ventricular hypokinesis, mimicking acute myocardial infarction.
  • Laboratory tests showed thrombocytopenia, renal dysfunction, and hemolysis, leading to a TTP diagnosis.

Findings:

  • Coronary angiography excluded obstructive coronary artery disease.
  • Postmortem examination confirmed myocardial microthrombi, indicative of ischemic cardiomyopathy.
  • The patient experienced rapid cardiopulmonary arrest despite preparation for plasma exchange.

Implications:

  • This case underscores the potential for TTP to cause acute ischemic cardiomyopathy.
  • Early recognition and treatment of TTP are crucial to prevent severe cardiovascular complications.
  • TTP should be considered in the differential diagnosis of myocardial dysfunction, especially in the presence of thrombocytopenia, hemolysis, and renal abnormalities.

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