Myocardial Infarction in a Young Man With Nephrotic Syndrome

Abstract

SummaryA 26-year-old man diagnosed with nephrotic syndrome (NS) 2 years previously presented with chest pain. An electrocardiogram (ECG) performed at a local hospital showed ST-elevation in chest leads. Cardiac troponin-I was significantly positive. Echocardiography revealed mild regional wall-motion abnormalities in the heart apex. Seven days later, angiography (CAG) revealed a thrombus in the left anterior descending branch (LAD). Tirofiban was injected into the LAD for thromboclasis. ECG after CAG showed the ST-segment was much lower than before. The diagnosis after CAG was ST-segment elevation myocardial infarction (MI) and thrombogenesis in the LAD. He continued to receive antiplatelet and anticoagulation medication and atorvastatin after CAG, and was discharged 3 days later. MI is very rare in young males, but the incidence of MI is 8 times higher than normal in patients with NS. For young patients with MI, clinicians should pay more attention to the history of previous diseases with high risk of thromboembolism and they should actively promote prevention and the treatment of renal disease patients to reduce the incidence of complications of thromboembolism. (Int Heart J 2017; 58: 275-278) Key words: Acte coronary events, Hypercoagulation M yocardial infarction (MI) is very rare in young males. Unlike older patients, in whom the rupture of an atherosclerotic plaque causing occlusion of the coronary artery is the main underlying pathology, the pathogenesis in younger patients can be varied, one of which is thromboembolism caused by nephrotic syndrome. We present here a case of MI in a young male. Case ReportA 26-year-old man presented to the emergency department with chest pain lasting 17 hours, preceded by cough for 7 days. He was diagnosed with nephrotic syndrome (NS) 2 years previously at Xiangya Second Hospital, and was being treated with prednisone to which he responded for about 12 weeks without any subsequent follow-up. He refused a kidney pathological examination at that time. There was no history of diabetes mellitus, hypertension, hepatitis B, malignant tumor, allergic purpura, systemic lupus erythematosus, connective tissue disease, or smoking. Before being transferred to our hospital, he was diagnosed with acute anterior myocardial infarction and an electrocardiogram (ECG) (Figure 1) at a local hospital showed ST-elevation in the chest leads. At the time of presentation, his blood pressure was 128/70 mmHg, his pulse rate 105 beats per minute, and his body temperature 36.7°C. Heart, lung, and abdominal examinations were negative. An ECG showed ST-elevation in the chest leads (Figure 2). Cardiac troponin-I (cTn-I) and MB isoenzyme of creatine kinase (CK-MB) were significantly positive. The provisional diagnosis was ST-segment elevation myocardial infarction (STEMI), with possible severe myocarditis. He refused primary percutaneous coronary angiography (CAG) because his chest pain relieved after he arrived at our hospital. Bedside echocardiography revealed mild regional wall-motion abnormalities...

Myocardial Injury Caused by Severe Blow

“…Regarding anticoagulation therapy, patients should be individually managed, taking into consideration the benefits and risks associated with the therapy. [5][6][7] In conclusion, we reported a patient with myocardial infarction who initially presented with blunt chest trauma. Careful medical interview and physical examination can be important clues to hidden diseases even in seemingly healthy subjects.…”