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ST-Elevation Myocardial Infarction (STEMI) Due to Left Ventricular Thrombus Embolization: Implications of Multiagent

Hemraj Paudel1, Hong Thoai Nguyen1, Muhammad Sohaib Alvi1

  • 1Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA.

Cureus
|February 5, 2025
PubMed

Insights

This case study details a rare instance of ST-elevation myocardial infarction (STEMI) in a young man. It suggests combination hormone replacement therapy (HRT) may increase the risk of thrombotic events and heart attack.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Acute coronary syndrome (ACS) typically affects older individuals with risk factors.
  • Younger patients with ACS and no traditional risk factors are uncommon.

Observation:

  • A 41-year-old physically active male on long-term combination hormone replacement therapy (HRT) (testosterone, tamoxifen, anastrozole) presented with ST-elevation myocardial infarction (STEMI).
  • The STEMI was complicated by peri-infarction pericarditis (PIP).
  • Diagnostic workup revealed a large thrombus occluding the left circumflex artery and a left ventricular (LV) thrombus.

Findings:

  • Revascularization attempts via thrombectomy were unsuccessful.
  • The patient was managed with therapeutic anticoagulation, standard ACS pharmacotherapy, and cessation of HRT.
  • He was discharged on warfarin for anticoagulation management.

Implications:

  • This case highlights potential cardiovascular risks, including thrombotic events and myocardial infarction, associated with combined HRT in younger individuals.
  • Clinicians and patients should be aware of the possible role of HRT in provoking such events.
  • Further research into the cardiovascular safety of combination HRT is warranted.

Keywords:
acute coronary syndrome (acs)anastrozolecardioembolichormone replacement therapy (hrt)left ventricle thrombusst-elevation myocardial infarction (stemi)tamoxifen therapytestosterone

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