Myocardial Infarction njury Is Relatively Common at Presentation of Acute Thrombotic Thrombocytopenic Purpura: The Indiana University Experience

Abstract

Although widespread vascular thrombosis is common in thrombotic thrombocytopenic purpura (TTP), there have been no prospective studies on the extent of injury to specific organs. Following successful resuscitation and plasma exchange of an index patient with widespread organ dysfunction, cardiogenic shock, and elevated cardiac troponin‐I levels, we prospectively studied and identified 2 more individuals (of 10 consecutive patients) with evidence of myocardial injury/infarction at presentation of acute TTP. These data suggest that cardiac troponin‐I measurements should be considered during initial evaluation of all patients with acute TTP.

Cardiovascular Manifestations in Patients With Thrombotic Thrombocytopenic Purpura: A Single‐center Experience

“…13 Several case reports have also observed the presence of silent AMI in patients with acute TTP. 8,9,14 In the present study, the incidence of AMI was 8 of 38 patients (21%) with TTP.…”

“…TTP most commonly involves solid organs and is manifested by the formation of platelet/fibrin thrombi within small blood vessels. 8 These thrombi usually cause classical symptoms and laboratory abnormalities and can lead to widespread organ dysfunction. The pancreas, adrenals, heart, brain, and kidneys have usually been found to contain focal areas of necrosis and hemorrhage.…”

“…4,8 Specific symptoms pointing to myocardial injury may not be elicited on initial clinical evaluation because these patients are often compromised in their ability to give a complete history due to neurological manifestations of TTP (disorientation, slurred speech, and aphasia). 8 Alternatively, chest discomfort may not be as alarming as other clinical manifestations of acute TTP (such as overt bleeding and stroke), and thus not volunteered by the patient as a primary complaint. 8 Several case reports and series have described AMI in patients with TTP.…”

“…8 Alternatively, chest discomfort may not be as alarming as other clinical manifestations of acute TTP (such as overt bleeding and stroke), and thus not volunteered by the patient as a primary complaint. 8 Several case reports and series have described AMI in patients with TTP. 9 -12 In a study by Patschan et al, the incidence of myocardial infarction was 13 of 32 patients (41%).…”

“…9 In a study by McCarthy et al, the incidence of myocardial infarction was 3 of 10 patients (30%) with TTP. 8 Ridolfi et al looked at 17 postmortem patients with TTP and found that 13 of the 17 patients (77%) had cardiac small-vessel thrombosis. 13 Several case reports have also observed the presence of silent AMI in patients with acute TTP.…”