Acute myocardial infarction in a patient with severe unrecognized mitral stenosis.
BACKGROUND
Acute myocardial infarction is a rare complication of mitral stenosis. Acute myocardial infarction in the setting of severe unrecognized mitral stenosis has not been described.


METHODS
A 47-year-old-woman was admitted to our department for chest pain typical of myocardial infarction. Electrocardiogram showed ST segment elevation in leads II, III, and aVF and atrial fibrillation. Creatine kinase level was elevated to 268 U/L. The diagnosis of acute myocardial infarction of the inferior wall was established. The patient reported breathlessness after physical exertion over the last 2 years; however, she had not sought medical help and was unaware of her heart disease. Transthoracic echocardiography showed severe mitral stenosis (surface mitral valve area <1 cm2) and inferior wall akinesia.


CONCLUSIONS
We present a case of acute myocardial infarction in a patient with unrecognized severe mitral stenosis and atrial fibrillation. Our suggestion is that acute myocardial infarction in this patient with no risk factors for coronary atherosclerosis was of thromboembolic origin, from left atrial thrombi.
Bajraktari
Gani
G
Cardiology Service, Internal Medicine Clinic, University Clinical Center, Prishtina, Kosova. ganibajraktari@yahoo.co.uk
Kastrati
Siada
S
Manaj
Rexhep
R
Berisha
Idriz
I
Thaqi
Sherif
S
Beqiri
Arton
A
Elezi
Shpend
S
D000700:Analgesics / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis; D004232:Diuretics / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D008790:Metoprolol / Q000627:therapeutic use; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis*; D017762:Nadroparin / Q000627:therapeutic use; D019821:Simvastatin / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
D000700:Analgesics; D000889:Anti-Arrhythmia Agents; D000924:Anticholesteremic Agents; D000925:Anticoagulants; D004232:Diuretics; D005343:Fibrinolytic Agents; D017762:Nadroparin; D006852:Hydrochlorothiazide; D019821:Simvastatin; D008790:Metoprolol; D001241:Aspirin