"Catch Me If You Can": Recurrent ST-Segment Elevation Myocardial Infarction Due to Aortic Thrombus

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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques

Published on: June 11, 2019

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Xinzhe James Cai1, Thuan Ngee Tan1, Siang Chew Chai1

  • 1Department of Cardiology, Changi General Hospital, Singapore.

JACC. Case Reports
|July 28, 2021
PubMed

Insights

A mobile aortic thrombus prolapsing into the right coronary ostium caused recurrent myocardial infarction in a patient with minimal coronary artery disease. This rare finding highlights the need for comprehensive cardiac imaging to identify unusual causes of heart attacks.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Interventional Cardiology

Background:

  • Recurrent ST-segment elevation myocardial infarction (STEMI) necessitates thorough etiological investigation, especially in cases with minimal atherosclerotic burden.
  • Aortic valve thrombus is an uncommon cause of coronary artery occlusion and myocardial infarction.

Observation:

  • A 42-year-old male experienced recurrent inferior STEMI despite minimal coronary atherosclerosis identified on intracoronary imaging.
  • Transesophageal echocardiogram and CT aortogram revealed a mobile thrombus originating from the right coronary cusp.

Findings:

  • The aortic thrombus was observed to prolapse into and out of the right coronary ostium, intermittently obstructing coronary blood flow.
  • This mechanical obstruction by the aortic thrombus was identified as the cause of the recurrent myocardial infarctions.

Implications:

  • This case underscores the importance of considering non-atherosclerotic causes of myocardial infarction, particularly mobile aortic thrombi.
  • Advanced cardiovascular imaging modalities are crucial for diagnosing rare cardiac pathologies causing ischemic events.
  • Prompt identification and management of aortic thrombi are essential to prevent recurrent ischemic events and improve patient outcomes.

Keywords:
ECG, electrocardiographyIVUS, intravascular ultrasoundPCI, percutaneous coronary interventionRCA, right coronary arteryRPAV, right posterior atrioventricular arterySTEMI, ST-segment elevation myocardial infarctionacute coronary syndromeaortathrombus

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