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St-Segment Elevation Myocardial Infarction Secondary to Left Main Coronary Artery Acute Thrombosis

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Published Date: March 15,2016

St-Segment Elevation Myocardial Infarction Secondary to Left Main Coronary Artery Acute Thrombosis

Andre R. Durães1*, de Araujo Machado PH1, de Souza Fernandes AM1Vasconcelos Muniz JQ2, and Roque Aras1,3

1Specialist in cardiology by the Brazilian Society of Cardiology, Hospital Santa Izabel, Salvador, Brazil

2Medicine student, Universidade Federal da Bahia, Brazil

3Assistant Professor of Cardiology in Universidade Estadual da Bahia, Brazil

*Corresponding author: Andre R. Durães, Rua Saldanha Marinho , S/N . Caixa dagua. Salvador-Bahia. Brazil, Tel: 55-71-8148-9582; E-mail: andreduraes@gmail.com

Citation: Durães AR, de Araujo Machado PH, de Souza Fernandes AM, Vasconcelos Muniz JQ, Roque Aras (2016) St-Segment Elevation Myocardial Infarction Secondary to Left Main Coronary Artery Acute Thrombosis. Arc Cas Rep CMed 2(1): 114. Doi: http://dx.doi.org/10.19104/crcm.2016.114

 

Keywords: Thrombosis; Myocardial Infarction

A 45-year-old man with history of hypertension and diabetes was admitted in a primary care facility complaining of progressive chest pain, retrosternal, tightening, radiating to left arm and diaphoresis that started at rest, 24 hours ago. A 12-lead electrocardiogram (ECG) showed ST-segment elevation of 2 mm in anterior leads (Figure 1), but unfortunately, no reperfusion strategy was made. After transfer to our service, he developed pulmonary congestion and he was sent to coronary angiography. This showed thrombus in left main coronary artery and total occlusion of left circumflex artery (Figure 2 and Video 1).  Because of thrombus migration risk with high potential for cardiac arrest, aggressive medical therapy with triple antiplatelet therapy and anticoagulation was chosen.

Figure 1: ECG showing sinusal rhythm, with ST-segment elevation of 2 mm in anterior leads and < 1 mm in inferior leads. 

 

Figure 2: Panel A and B: Left main coronary angiogram in right anterior oblique views. It is noteworthy negative image occupying almost 100% of the vessel lumen.

 

Dual antiplatelet therapy, with abciximab and enoxaparin 1 mg/kg every 12 hours, was initiated. After seven days, a new coronary angiography showed almost complete resolution of the thrombus. (Figure 3, Video 2). The patient was discharged asymptomatic after dose adjustment of warfarin. ST elevation myocardium infarction continues to be a significant public health problem in industrialized countries and it is becoming an increasingly significant problem in developing countries [1]. Coronary spasm should be regularly considered in the differential diagnosis [2].

Figure 3: Panel A and B: Left main coronary angiogram in right anterior oblique views. It is observed the disappearance of the negative image seen in the previous figure.

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Videos

Left main coronary artery in right anterior oblique caudal view and after in anterior oblique caudal view: findings suggestive of subtotal occlusion of the left main stem and total occlusion of circumflex artery

 

Left main coronary artery in right anterior oblique cranial without occlusion of the left main stem and/or circumflex artery

 

References

 

  1. AAmerican College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions, O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78-140. doi: 10.1016/j.jacc.2012.11.019.
  2. Ong P, Athanasiadis A, Hill S, Vogelsberg H, Voehringer M, Sechtem U. Coronary Artery Spasm as a Frequent Cause of Acute Coronary Syndrome: The CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) Study. J Am Coll Cardiol. 2008;52(7):523-7. doi: 10.1016/j.jacc.2008.04.050.

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Copyright: © 2016 Durães AR, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.