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Recurrent myocardial infarction with patent coronary arteries
L J Haywood1, A H Khan, J Bornheimer
1Department of Medicine, Los Angeles County+USC Medical Center, USA.
Journal of the National Medical Association
|June 1, 1997
Summary
A young male experienced recurrent myocardial infarction, leading to heart failure and death. Autopsy revealed apical mitral thrombosis as the source of systemic emboli, highlighting a rare cause of infarction and thromboembolism.
Area of Science:
- Cardiology
- Nephrology
- Pathology
Background:
- Recurrent myocardial infarction in young adults is uncommon.
- Systemic embolization can lead to multi-organ failure.
- Mitral valve thrombosis is a rare but serious complication.
Observation:
- A 25-year-old male presented with two distinct episodes of severe chest pain, consistent with acute myocardial infarction.
- Cardiac catheterization revealed myocardial dysfunction with apical akinesis/dyskinesis and patent coronary arteries, suggesting non-atherosclerotic causes.
- The patient later developed flank pain, hematuria, progressive renal failure, cardiac decompensation, and intractable arrhythmias.
Findings:
- Autopsy identified a large apical mitral thrombosis.
- This thrombosis was the presumed source of multiple systemic emboli.
- Recanalization of the right coronary artery was noted, suggesting prior pathology.
Implications:
- Mitral thrombosis can be a source of systemic emboli, leading to infarction and multi-organ failure.
- This case underscores the importance of investigating rare causes of myocardial infarction and embolism in young patients.
- Comprehensive autopsy is crucial for identifying the underlying etiology of complex clinical presentations.