Acute anterior myocardial infarction as first manifestation of acute myeloid leukemia.
A 42-year-old man was admitted with heavy retrosternal pain lasting 30 min. Electrocardiography showed typical signs of acute anterior myocardial infarction. The patient reported only attacks of coughing for a couple of days, and no serious diseases. The physical examination was normal. Laboratory tests showed a white blood cell count of 45/nl, platelet count of 58/nl, and hemoglobin of 14.4 g/dl. Blood chemistry showed elevated lactic dehydrogenase (413 U/l) but no elevation in creatine phosphokinase or glutamic-oxaloacetic transaminase. Therefore no thrombolysis was administered, but coronary angiography was performed. This showed a long-distance, subtotal thrombotic occlusion of the left anterior descending artery. After percutaneous transluminal coronary angioplasty and implantation of serial stents a normal perfusion of the artery was observed. The patient's blood and bone marrow films revealed acute myeloid leukemia FAB M2. Various conditions can cause a myocardial infarction in leukemias. We discuss the clinical management and the possible reasons for a subtotal thrombotic occlusion of the coronary artery.
Jachmann-Jahn
U
U
Medizinische Klinik, Krankenhaus Köln-Holweide, Cologne, Germany. tujahn@netcologne.de
Cornely
O A
OA
Laufs
U
U
Höpp
H W
HW
Meuthen
I
I
Krakau
M
M
O'Brien
B
B
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000150:complications; D001854:Bone Marrow Cells / Q000473:pathology; D017023:Coronary Angiography; D004334:Drug Administration Schedule; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology