Myocardial infarction in patients with severe beta thalassaemia: a case series

Area of Science:

• Cardiology
• Hematology
• Internal Medicine

Background:

• Cardiac disease is a leading cause of morbidity and mortality in thalassemia patients, especially those with thalassemia major.
• Myocardial infarction and coronary artery disease are seldom reported in this population.
• This study examines rare cases of acute coronary syndrome in patients with thalassemia syndromes.

Purpose of the Study:

• To investigate the presentation and potential etiology of acute coronary syndrome (ACS) in patients with thalassemia.
• To highlight the diagnostic and therapeutic challenges in managing ACS in this unique patient group.

Main Methods:

• Case series of three adult patients with distinct thalassemia syndromes presenting with ACS.
• Detailed review of clinical presentation, transfusion history, cardiac investigations including coronary angiography, and management.
• Analysis of etiological factors, distinguishing between atherosclerotic and non-atherosclerotic causes.

Main Results:

• Two heavily transfused patients experienced ST-elevation myocardial infarctions (STEMI); one minimally transfused patient had unstable angina.
• Coronary angiography revealed normal findings in two patients; one STEMI patient had a 50% plaque.
• All patients were managed with standard ACS protocols, despite a presumed non-atherogenic etiology.

Conclusions:

• The precise cause of ACS in these thalassemia patients remains undetermined.
• The optimal use of thrombolytic therapy, primary percutaneous coronary intervention, antiplatelet agents, and high-dose statins in this subgroup requires further clarification.