[Homozygous form of factor V Leiden mutation as the cause of a myocardial infarction in patient with an unremarkable coronary vascular system?].
METHODS
A 32-year-old smoker was referred to our hospital for the evaluation of acute chest pain. 9 years earlier he had had a non Q-wave myocardial infarction. At that time, angiography showed widely patent coronary arteries without atherosclerotic lesions.


METHODS
Electrocardiographic as well as creatine kinase patterns were consistent with an acute transmural myocardial infarction. Cholesterol, triglyceride und homocysteine levels were normal. The patient was homozygous for the factor V Leiden mutation.


METHODS
Thrombolysis was performed with streptokinase followed by coronary angiography showing a patent left coronary system and a non-occlusive thrombosis in the distal part of the right coronary artery. Body weight adapted abciximab infusion was started immediately. 9 weeks later coronary angiography was repeated. Now, in the distal part of the right coronary artery a minor dissection was seen followed by a not flow-limiting stenosis.


CONCLUSIONS
On the evidence of this case history, we think it possible that the pronounced thrombophilia created by the homozygous factor V Leiden mutation may provoke myocardial infarction even if the atherosclerotic lesions are still too trivial to be detected by angiography.
Menge
H
H
Abteilung für Kardiologie, Pneumologie und Intensivmedizin, Medizinische Klinik, Klinikums Remscheid GmbH.
Faig
H G
HG
Lang
A
A
Fahrenkrog
U
U
Löllgen
H
H
D000328:Adult; D017023:Coronary Angiography; D004562:Electrocardiography; D005165:Factor V / Q000235:genetics*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006720:Homozygote; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D017354:Point Mutation; D012907:Smoking / Q000009:adverse effects; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy
D005343:Fibrinolytic Agents; C095381:factor V Leiden; D005165:Factor V; D013300:Streptokinase