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

Acute coronary syndrome (ACS) primarily affects older individuals with established risk factors, but its occurrence in younger patients without traditional risk factors is rare and warrants attention. We present the case of a 41-year-old physically active male patient on long-term combination hormone replacement therapy (HRT) (testosterone, tamoxifen, and anastrozole) who developed ST-elevation myocardial infarction (STEMI) complicated by peri-infarction pericarditis (PIP). A diagnostic workup revealed a large thrombus occluding the left circumflex artery and a left ventricular (LV) thrombus. Despite attempts at thrombectomy, revascularization was unsuccessful, and the patient was managed with therapeutic anticoagulation, standard ACS pharmacotherapy, and cessation of hormone therapy. He was discharged on warfarin and continues regular follow-up at the anticoagulation clinic. His first follow-up visit to cardiology is yet to occur. This case highlights the potential cardiovascular risks associated with combined HRT, underscoring the need for clinicians and patients to be aware of its possible role in provoking thrombotic events and myocardial infarction in younger individuals.