title: [Myocardial infarction of rare etiology in a young adult].
abstract: Chest pain is not uncommon among young patients below the age of 35 years, however, it is rarely caused by acute coronary syndrome. The rarity of coronary artery occlusion in this population can easily lead to diagnostic mistakes. The authors present the case history of a 19-year-old young female, who was admitted to the emergency department of a local hospital due to the sudden onset of chest pain and malaise. ST-segment elevation was seen on the electrocardiogram raising the possibility of aortic dissection, therefore, emergency thoracic computed tomographic scan was performed. This proved to be negative and the patient was transferred to the coronary care unit. Urgent coronarography was carried out, which revealed the total occlusion of the left main coronary artery. The occluded artery was successfully opened with percutaneous coronary intervention, but despite revascularisation the patient died on the second postoperative day due to asystole. Autopsy revealed thrombotic embolization of the left main artery with consequent extensive haemorrhagic necrosis, involving almost the whole left ventricle. The source of embolization was not found. The authors note that left coronary artery occlusion in young patients can be a diagnostic challenge, because symptoms can be mistaken with aortic dissection or pulmonary embolism.
authors.affiliation: I. Belgyógyászat, Kardiológiai Osztály, Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktatókórház Miskolc, Szentpéteri kapu 72-76., 3526.
authors.forename: Gábor Zoltán
authors.initials: GZ
authors.lastname: Nagy
authors.forename: Gábor
authors.initials: G
authors.lastname: Gerges
authors.forename: Kálmán
authors.initials: K
authors.lastname: Csapó
authors.forename: Erika
authors.initials: E
authors.lastname: Csengő
authors.forename: Károly
authors.initials: K
authors.lastname: Minik
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D000784:Aortic Dissection / Q000175:diagnosis; D056988:Anterior Wall Myocardial Infarction / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D001344:Autopsy; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004638:Emergency Treatment; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006329:Heart Conduction System / Q000503:physiopathology*; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D009336:Necrosis / Q000209:etiology; D062645:Percutaneous Coronary Intervention; D013923:Thromboembolism / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: aortadissectio; aortic dissection; bal közös törzs; differenciáldiagnózis; differential diagnosis; embolia; embolism; fiatal beteg; left main coronary artery; pulmonalis embolia; pulmonary embolization; young patient