Recurring ST-Elevation Myocardial Infarction With No-Reflow Caused by Hypercoagulable State: A Behcet Disease Case
Ahmed Hegazi Abdelsamie1, Nayef Al-Asiri1
1Cardiac Center, Mouwasat Hospital Al-Jubail Industrial City, Jubail, Saudi Arabia.
Insights
Young adults experiencing acute myocardial infarction (AMI) may have undiagnosed Behcet disease (BD). Early BD diagnosis and treatment are crucial for managing cardiac complications and preventing recurrent events.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Acute myocardial infarction (AMI) in young patients presents unique challenges due to potential long-term health and social impacts.
- Behcet disease (BD) is a rare multisystem autoimmune disorder where cardiac involvement, though uncommon, can manifest as a primary symptom.
Observation:
- A 33-year-old male smoker with no prior medical history presented with acute inferior myocardial infarction.
- Coronary angiography revealed extensive thrombosis in the right coronary artery, necessitating primary stenting and subsequent interventions due to acute stent thrombosis.
Findings:
- The patient's history of recurrent oral and genital ulcers, coupled with a positive HLA-B51 allele, indicated a strong association with Behcet disease.
- Arterial thrombosis in this young adult was attributed to a hypercoagulable state secondary to an early manifestation of Behcet disease.
Implications:
- This case highlights the importance of considering Behcet disease in young adults presenting with arterial thrombosis and myocardial infarction.
- Increased awareness and timely diagnosis of cardiac manifestations in Behcet disease are vital for reducing morbidity and mortality.
- Therapeutic strategies involving corticosteroids and colchicine may prove beneficial in managing cardiac complications associated with Behcet disease.
Abstract:
Acute myocardial infarction (AMI) in young patients is an important issue because of its impact on health and social life. The mechanisms and disease courses of ST-elevation myocardial infarction (STEMI) in young individuals may differ from those in the elderly. Behcet disease (BD) is a multisystem autoimmune disorder of unknown etiology. Cardiac involvement is rare, yet it was reported to affect 6% of patients, with 17% of the cases presenting as the first manifestation. We present the case of a 33-year-old male heavy smoker with negative medical history, who presented with acute inferior myocardial infarction. His coronary angiography showed huge thrombosis in proximal right coronary artery. He was treated with primary coronary intervention and implantation of drug-eluting stent, with subsequent intervention and implantation of two more drug-eluting stents due to acute stent thrombosis within 48 h. Rheumatologic assessment revealed the history of four different attacks of oral ulcers and one attack of genital ulcer. His workup showed positive human leukocyte antigen (HLA) allele (B51) which is strongly associated with BD. AMI in young adults due to arterial thrombosis can be attributed to hypercoagulable state related to early manifestation of BD. Increased knowledge of AMI in young adults and its presentation in BD is necessary to reduce morbidity and mortality. Corticosteroids and colchicine may improve cardiac manifestations in BD.
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