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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.
Insights
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.
Abstract:
Two separate episodes of severe chest pain occurred several years apart in a 25-year-old male patient with typical clinical findings of acute myocardial infarction with each episode. Cardiac catheterization following the second infarction confirmed the presence of myocardial dysfunction with apical akinesis and dyskinesis. Both coronary arteries were radiologically patent; however, there was evidence of probable recanalization of the right coronary artery. Several months later, the patient developed flank pain, hematuria, progressive renal failure, and cardiac decompensation, and died with intractable arrhythmias. At autopsy, a large apical mitral thrombosis was found and was the presumptive source of multiple systemic emboli.