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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
An ST elevation myocardial infarction with multisystemic embolization: a shocking and striking first presentation of
Meryem Haboub1, Ilyas Atlas1, Abdenasser Drighil1
1Cardiology Department, University Hospital Ibn Rochd, 8, street Lahcen El Arjoun, 20100 Casablanca, Morocco.
Insights
Anti-phospholipid syndrome, a rare autoimmune disorder, can cause severe arterial thrombosis. This case highlights thrombotic coronary occlusion leading to myocardial infarction and multisystemic embolization in a young woman.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Anti-phospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent thrombosis in the presence of anti-phospholipid antibodies.
- Arterial thrombosis, a known complication of APS, can lead to severe and life-threatening manifestations.
Observation:
- A 38-year-old woman presented with acute chest pain, diagnosed as myocardial infarction due to thrombotic coronary occlusion.
- Echocardiography revealed multiple intra-left ventricular thrombi, leading to multisystemic embolization including femoral arteries, renal, and splenic infarcts.
- Positive anti-cardiolipin antibodies confirmed the diagnosis of APS.
Findings:
- The patient experienced a rare but dramatic manifestation of APS involving coronary artery thrombosis.
- Multisystemic embolization occurred secondary to intra-left ventricular thrombi.
- Treatment with aspirin and vitamin K antagonists resulted in complete resolution of left ventricular thrombi.
Implications:
- This case underscores the potential for severe arterial complications in APS, even in young individuals.
- Early diagnosis and aggressive anticoagulation are crucial for managing APS-related thrombotic events.
- The findings emphasize the importance of considering APS in cases of unexplained arterial thrombosis and myocardial infarction.
Introduction:
Anti-phospholipid syndrome is characterized by venous and/or arterial thrombosis in the presence of anti-phospholipid antibodies. We report a rare and dramatic manifestation of the syndrome: thrombotic coronary occlusion leading to myocardial infarction, resulting in multiple intra-LV thrombi responsible for multisystemic embolization.
Case Presentation:
We report the case of a 38-year-old Caucasian woman, who presented to the emergency department with acute chest pain. On initial clinical examination, the patient was tachycardiac at 123 b.p.m. with a correct blood pressure of 127/69 mmHg. The electrocardiogram showed sinus tachycardia at 125 b.p.m. with QS waves in the anteroseptal with persistent ST-segment elevation in the same territory. Transthoracic echocardiography revealed left ventricle ejection fraction of 35% with several intra-left ventricular (LV) thrombi. Troponin Ic was elevated at 5668 ng/L. The diagnosis of myocardial infarction was suspected and the patient was treated as such. Eight hours after admission, the patient presented with an embolization to both common femoral arteries which was treated by Fogarty embolectomy. The patient underwent coronary angiography, which revealed thrombotic occlusion of the proximal left anterior descending artery. A cerebro-thoraco-abdomino-pelvic computed tomography scan found a right renal infarct and a splenic infarct. Lab tests revealed positive anti-cardiolipin antibodies. Anti-phospholipid syndrome was confirmed and the patient was treated using aspirin and vitamin K antagonists. The evolution was marked by complete resolution of LV thrombi and the patient is actually asymptomatic apart from a slight exertional dyspnoea.
Conclusion:
Anti-phospholipid syndrome is an autoimmune disorder whose complications can be life-threatening and/or functionally disabling. Arterial thrombosis can cause dramatic complications.
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