[41-year-old female patient with ST-elevation myocardial infarction and multiple arterial emboli].
A 41-year-old woman presented with acute angina in the emergency unit. Additionally, she reported pain in both legs and a weight loss of 5 kilograms within the last 10 days. ECG revealed an acute anterior myocardial infarction. However, immediate coronary angiography showed open arteries with minimal arteriosclerosis. A characteristic rise of cardiac enzymes together with an akinesis of the anterior wall and an adjacent mural thrombus was highly suggestive of a transient coronary thrombosis. Further investigations showed occlusion of multiple arteries in both legs and a splenic infarct. Although there was a typical risk profile including smoking, hyperlipidemia and regular estrogen medication, a further work-up was started. Urin analysis was decisive for the presence of proteinuria and a severe nephrotic syndrome. The definite diagnosis was made by direct biopsy of the kidney that revealed the characteristic findings of a minimal change glomerulopathy. Rapid remission could be induced by high-dose oral steroids. During routine work-up of coronary syndromes, especially in those with normal coronaries, rare but treatable causes of myocardial infarction and coagulopathy have to be thought of and should carefully be excluded.
Bramstedt
J
J
Medizinische Klinik II, Kardiologie und Nephrologie, Klinikum Bremerhaven Reinkenheide, Postbrookstrasse 103, Bremerhaven, Germany. joern.bramstedt@klinikum-bremerhaven.de
Schröder
J
J
Dissmann
R
R
D000208:Acute Disease; D000328:Adult; D000789:Angina, Unstable / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004617:Embolism / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D009404:Nephrotic Syndrome / Q000150:complications / Q000175:diagnosis*; D058729:Peripheral Arterial Disease / Q000175:diagnosis*; D011507:Proteinuria / Q000175:diagnosis*