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Myocardial infarction in sickle cell disease
C R Martin1, C S Johnson, C Cobb
1Department of Medicine, LAC+USC Medical Center 90033, USA.
Journal of the National Medical Association
|July 1, 1996
Summary
Sickle cell disease patients can experience myocardial infarction (heart attack) without typical atherosclerosis. This suggests a need to consider ischemic heart disease in these patients presenting with chest pain.
Area of Science:
- Cardiology
- Hematology
- Pathology
Background:
- Sickle cell disease (SCD) is a genetic blood disorder.
- Cardiac complications are increasingly recognized in SCD.
- Myocardial infarction (MI) is not commonly associated with SCD.
Purpose of the Study:
- To investigate the prevalence and characteristics of myocardial infarction in patients with sickle cell disease.
- To explore potential underlying mechanisms of MI in this population.
Main Methods:
- Autopsy study of 72 consecutive hearts from patients with sickle cell disease.
- Analysis of gross and microscopic findings for evidence of myocardial infarction.
- Review of clinical data including chest pain and ECG findings.
Main Results:
- Myocardial infarction (acute or healed) was found in 9.7% (7/72) of patients.
- No obstructive atherosclerotic lesions were observed in the affected patients.
- Microthrombi were present in the arterioles of infarcted tissue in two patients.
- Chest pain was reported by 6/7 patients; ECG changes were noted in 2/7.
- One patient experienced sudden death.
Conclusions:
- Ischemic heart disease, including myocardial infarction, may be a significant but underrecognized complication in sickle cell disease.
- Pathophysiological mechanisms may involve anemia, platelet thrombi, vasospasm, and abnormal sickle cell rheology, rather than atherosclerosis.
- Chest pain in SCD patients warrants consideration of ischemic heart disease, irrespective of crisis status.