Simultaneous manifestation of acute myocardial infarction and nephrotic syndrome

Abstract

Summary: This report describes the simultaneous manifestation of ischemic heart disease and nephrotic syndrome in a 37-year-old woman presenting with acute anterior myocardial infarction. Symptoms of nephrotic syndrome, such as facial and peripheral edema accompanied by proteinuria and hyperlipidemia, and onset of severe retrostemal pain developed within 24 h. Coronary angiography revealed a complete thrombotic occlusion of the proximal portion of the left anterior descending artery with no evidence of arteriosclerotic lesions. Histologic examination of renal biopsy, including electron microscopy, revealed evidence of minimal change glomerulonephritis. Ultrastructural studies demonstrated widespread effacement of epithelial foot processes. Elevated levels of circulating fibrinogen appeared to be an important factor for the hypercoagulable state in this patient, suggesting a causative relationship between coronary thrombosis and nephrotic syndrome.

Premature acute myocardial infarction in a child with nephrotic syndrome

“…Taylor [13] reported a rare occurrence of myocardial infarction in a rural black African 44-year-old female. Recently, other authors have reported acute myocardial infarction secondary to thrombotic complications in young adults with nephrotic syndrome [14,15,16].…”

Myocardial Infarction and Pulmonary Arterial Hypertension in a Young Patient with Systemic Lupus Erythematosus

“…Coronary thrombosis can be seen in hypercoagulable state, as in nephrotic syndrome [3], antiphospholipid syndrome [4], deficiencies of protein C, protein S and antithrombin III [5,6]. Renal involvement associated with nephritic syndrome may result in hypercoagulability, thus leading to AMI [3,7]. There are case reports and some small-sized series available that address development of AMI in young patients with SLE below 35 year [8].…”

Nephrotic and Anti‐phospholipid Syndromes: Multisystem Conditions Associated With Acute Myocardial Infarction in Young Patients

“…This can be a significant factor in the development of arterial thrombus since arterial thrombi are mainly composed of platelets as compared to venous thrombi, which are predominantly formed from fibrin and red cells (Fahal et al . 1994; Meyer et al 1998). Increased blood viscosity secondary to haemoconcen‐tration due to diuretic use and high fibrinogen concentration can also contribute towards the thrombotic tendencies in nephrotic patients (Fahal et al .…”

“…The first report of MI complicating NS was published by Berlyne & Mallick (1969). Since then few case reports describing MI in young patients with longstanding NS and simultaneous presentation of MI and NS have also been published (Meyer et al 1998; Osula et al . 2002).…”

“…MI in such a setting can sometimes be the first manifestation of an underlying disease. Accurate diagnosis is imperative for appropriate management and secondary prevention (Meyer et al 1998; Osula et al 2002; Davies & Hunt 2007).…”