Abstract
Acute myocardial infarction (MI) in young adults is rare. Clinicopathological conditions such as nephrotic syndrome, antiphospholipid syndrome, spontaneous coronary artery spasms or embolism can be attributed to such events. In this case report, we present a 30-year-old male who had his first MI at the age of 20 years. He received percutaneous intervention as initial treatment. Despite aggressive risk factor management, he continued to have acute coronary events and was later diagnosed with antiphospholipid syndrome (APS). At the same time, he was diagnosed with severe chronic thromboembolic pulmonary hypertension and severe tricuspid regurgitation. He underwent pulmonary endartererectomy, tricuspid annuloplasty and radial artery bypass graft to the first obtuse marginal artery. Warfarin therapy was initiated upon the diagnosis of APS. Despite being therapeutic on warfarin and aggressive risk factor management, he had yet another MI. Coronary angiogram at this time showed fresh occlusion of the right coronary artery at the mid-segment, and the patient received two overlapping stents that achieved a good effect. This case emphasizes the importance of awareness, early recognition and aggressive management of patients with APS presenting chest pain or acute coronary events. Despite appropriate treatment, such as risk factor management and percutaneous interventions, recurrence of an acute coronary event is high. The presentation of younger patients with recurrent coronary events but no significant risk factors of atherosclerosis should evoke the suspicion of APS-related coronary artery disease, and all risk factors should be aggressively managed.
Similar content being viewed by others
References
Mc Gill HC, McMahan CA, Zieske AW et al (2000) Association of coronary heart disease risk factors with microscopic qualities of coronary atherosclerosis in youth. Circulation 102:375–379
Osula S, Bell GM, Hornug RS (2002) Acute myocardial infarction in young adults: causes and management. Postgrad Med J 78:27–30
Cervera R, Piette JC, Font L et al (2002) Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1000 patients. Arthritis Rheum 46:1019–1027
Hughes GRV, Harris NN, Gharavi AE (1986) The anticardiolipin syndrome. J Rheumatol 13:486–489
Miyakis S, Lockshin MD, Atsumi T et al (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome. J Thromb Haemost 4:295–306
Tincani A, Rebaioli CB, Taglietti M, Shoenfeld Y (2006) Heart involvement in systemic lupus erytematosus, anti-phospholipid syndrome and neonatal lupus. Rheumatology 45:iv8–iv13
Hojnik M, George J, Ziporen L, Shoenfeld Y (1996) Heart valve involvement (Libbman-Sacks endocarditis) in the antiphospholipid syndrome. Circulation 93:1579–1587
Wu R, Nityanad S, Berglund L et al (1997) Antibodies against cardiolipin and oxidatively modified LDL in 50-year-old men predicts myocardial infarction. Arterioscler Thromb Vasc Biol 17:3159–3316
Salmon JE, Roman MJ (2001) Accelerated atherosclerosis in systemic lupus erythematosis: implications for patient management. Curr Opin Rheumatol 13:341–344
Van Doornum S, McColl G, Wicks IP (2002) Accelerated atherosclerosis. An extraarticular feature of rheumatoid arthritis? Arthritis Rheum 46:862–873
Doria A, Sherer Y, Meroni PL, Shoenfeld Y (2005) Inflammation and accelerated atherosclerosis: basic mechanisms. Rheum Dis Clin North Am 31:355–362
Doria A, Shoenfeld Y, Pauletto P (2004) Premature coronary artery disease in systemic lupus. N Eng J Med 350:1571–1575
George D, Erkan D (2009) Antiphospholipid Syndrome. Prog Cardiovasc Dis 52(2):115–125
Lockshin M, Tenedios F, Petri M et al (2003) Cardiac disease in the antiphospholipid syndrome: recommendations for treatment Committee consensus report. Lupus 12(7):518–523
Jury EC, Ehrenstein MR (2005) Statins: immunomodulators for autoimmune rheumatic disease? Lupus 14:192–196
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Thapamagar, S.B., Aung, T.T. & Mascarenhas, D. Recurrent acute coronary events in a young adult. J Thromb Thrombolysis 35, 290–294 (2013). https://doi.org/10.1007/s11239-012-0796-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11239-012-0796-5