Myocardial Infarction in an Adolescent Fontan Patient Who Consumed Energy Drinks on a Daily Basis and Stopped Thromboprophylaxis: A Case Report

Abstract

Patients with single ventricle type congenital heart disease show a variety of risk factors for thromboembolic complications leading to stroke, pulmonary embolism and rarely myocardial ischemia. Energy drink consumption has been associated with adverse effects on vascular function and coagulation and may increase the risk. We report a case of a 14-year-old Fontan patient who presented with new onset cyanosis, chest pain and syncope. He quitted antiplatelet therapy himself three years ago and consumed three energy drinks a day regularly. On admission cardiac enzymes were severely elevated ECG showed slightly elevated ST-segments and Echo demonstrated reduced function. Myocarditis was first suspected but was rejected after MRI depicted a large transmural scar. During cardiac catheterization a total occlusion of the entire right coronary artery leading to myocardial infarction was found. The patient was put on dual anticoagulation and scheduled for transplantation because of severe myocardial impairment but did not consent and ultimately died. Myocardial infarction is an extremely rare complication in the Fontan population that has to be considered and ruled out in a timely manner in patients who present with chest pain and elevated troponin T to preserve ventricular function. Continuous thromboprophylaxis and avoidance of additional risk factors like energy drinks is warranted to prevent thromboembolic events in this population.