title: Near simultaneous atherothrombotic occlusion of two coronary arteries challenges the theory of the single vulnerable plaque.
abstract: BACKGROUND
  It is unlikely that mechanical stress altering a single vulnerable plaque leads to myocardial infarction from almost simultaneous proximal atherothrombotic closure of the right coronary artery and the left anterior descending coronary artery. ACUTE MANAGEMENT: Immediate catheter diagnosis and revascularization including stent deployment restored TIMI III flow in both coronary arteries. After an initial bolus, abciximab was continuously infused to optimize myocardial perfusion. LABORATORY TESTS ON ADMISSION: The patient's white blood cell count was markedly elevated and the level of C-reactive protein slightly so. After interventional recanalization, C-reactive protein rose steeply before falling again after two days.
  
  
  RESULTS
  Thirty days after acute myocardial infarction, the patient was fully recovered and asymptomatic. Echocardiography revealed only mild-to-moderate global left ventricular hypokinesia.
  
  
  CONCLUSIONS
  Widespread inflammation associated with multifocal plaque rupture and subsequent two-vessel acute myocardial infarction is a rare phenomenon, usually associated with sudden cardiac death. Widespread inflammation is one of the reasons why the widely accepted theory of the single vulnerable plaque for such events can be contradicted.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria. thomas.bartel@i-med.ac.at
authors.forename: Thomas
authors.initials: T
authors.lastname: Bartel
authors.forename: Renate
authors.initials: R
authors.lastname: Hiemetzberger
authors.forename: Silvana
authors.initials: S
authors.lastname: Müller
authors.forename: Otmar
authors.initials: O
authors.lastname: Pachinger
mesh_terms: D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D002097:C-Reactive Protein / Q000378:metabolism; D006328:Cardiac Catheterization; D002932:Cineangiography; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D003328:Coronary Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019233:Retreatment; D015607:Stents; D020107:Troponin T / Q000097:blood
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D020107:Troponin T; D002097:C-Reactive Protein; D000077284:Abciximab