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Transmural myocardial infarction with the prolapsing mitral-leaflet syndrome and normal coronary arteries
Archives of Internal Medicine
|September 1, 1978
Insights
Myocardial infarction occurred in two patients with prolapsing mitral-leaflet syndrome, despite normal coronary angiograms and lipid levels. Potential causes include coronary artery embolism or prolonged spasm.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Pathophysiology
Background:
- Prolapsing mitral-leaflet syndrome (PMLS) is a common valvular condition.
- Myocardial infarction (MI) is typically associated with coronary artery disease.
- PMLS is not usually linked to ischemic cardiac events.
Observation:
- Two patients, a 38-year-old woman and a 17-year-old boy, presented with clinical and electrocardiographic evidence of transmural myocardial infarction.
- Both patients had PMLS.
- Neither patient had obstructive coronary artery disease on angiography nor abnormal plasma lipid levels.
Findings:
- Left ventricular angiography revealed dyskinetic areas in both patients, indicative of myocardial damage.
- The transmural myocardial infarction in these young patients with PMLS and normal coronary arteries was unexpected.
- The underlying mechanism remains unclear but may involve coronary artery embolism or prolonged coronary artery spasm.
Implications:
- This case series suggests a potential link between PMLS and myocardial infarction in the absence of traditional risk factors.
- Further research is needed to elucidate the pathophysiology connecting PMLS to myocardial infarction.
- Clinicians should consider PMLS as a potential factor in young patients presenting with myocardial infarction and normal coronary arteries.
Abstract:
Clinical and electrocardiographic evidence of transmural myocardial infarction developed in two patients (a woman, age 38, and a boy, age 17) with prolapsing mitral-leaflet syndrome. Both had normal coronary angiograms and normal plasma lipid levels. Left ventricular angiography showed dyskinetic areas in both patients. Coronary artery embolism or prolonged coronary artery spasm may have been the underlying mechanism of production of myocardial infarction.