A 34-Year-Old Man With Exercise-Induced ST-Segment Elevation Myocardial Infarction 36 Hours After Descent From High...

BACKGROUND Prolonged exposure to high altitude can increase the risk of coronary artery disease, acute coronary syndrome, and other ischemic cardiovascular events. This report describes the case of a 34-year-old man with exercise-induced ST-segment elevation myocardial infarction (STEMI) 36 hours after descent from high altitude. CASE REPORT A previously healthy 34-year-old man presented with 9 hours of crushing substernal chest pain. Electrocardiogram (ECG) demonstrated anteroseptal ST-segment elevation in leads V1-V3 with reciprocal changes in inferior leads. Emergency coronary angiography (CAG) revealed total occlusion with a high thrombus burden of the proximal left anterior descending (LAD) artery with TIMI 0 flow, accompanied by diffuse non-culprit coronary plaques (30-40% stenosis). Primary percutaneous coronary intervention (PCI) with drug-eluting stent implantation restored TIMI 3 flow. The event occurred 36 hours after descent from 4200 m altitude, immediately following intensive exercise, suggesting a temporal association between early de-acclimatization and acute coronary events. CONCLUSIONS Multiple factors, including dyslipidemia, residual hemorheological changes after high-altitude exposure, and vigorous exercise, may be associated with the occurrence of acute myocardial infarction (AMI) during high-altitude de-acclimatization. This report highlights the importance of recognizing that patients with a history of living at high altitude can be at increased risk of acute coronary syndromes, particularly ST-segment elevation myocardial infarction, when undertaking exercise.