A Double Threat: Concurrent Non-ST-Elevation Myocardial Infarction and Transient Ischemic Attack Symptoms Revealing...

Area of Science:

• Cardiology
• Neurology
• Pharmacology

Background:

• Acute myocardial infarction (AMI) can lead to impaired ventricular function, promoting intracardiac thrombus formation.
• Endothelial dysfunction and ischemia following AMI expose thrombogenic material, increasing thromboembolic risk.
• Embolization of cardiac thrombi can result in severe neurological events, including stroke and transient ischemic attack (TIA).

Observation:

• A 56-year-old male with hypertension and methamphetamine use presented with chest pain, dyspnea, and transient left-sided weakness.
• Work-up revealed elevated troponin, severe triple-vessel coronary artery disease, and an apical mural thrombus with reduced ejection fraction (45%).
• The patient also developed paroxysmal atrial flutter, a known risk factor for thromboembolism.

Findings:

• Methamphetamine use is associated with accelerated atherosclerosis and increased thromboembolic risk, likely contributing to the patient's complex cardiac condition.
• Transthoracic echocardiography confirmed an apical mural thrombus, indicating a significant risk of systemic embolization.
• The patient was initiated on anticoagulation therapy with enoxaparin, bridging to warfarin, for management of the mural thrombus.

Implications:

• This case underscores the critical need for heightened clinical vigilance in patients with methamphetamine use presenting with cardiac symptoms.
• Prompt anticoagulation and comprehensive cardiac evaluation are essential for identifying and managing mural thrombus and preventing embolic complications.
• Even with initially negative cerebrovascular imaging, the potential for embolic events necessitates thorough cardiac assessment in methamphetamine-associated myocardial injury.