Endothelial Nitric Oxide Synthase T-786C Mutation, Prothrombin Gene Mutation (G-20210-A) and Protein S Deficiency Could Lead to Myocardial Infarction in a Very Young Male Adult.
BACKGROUND
Myocardial infarction is a rare medical event in young people. The main reasons include congenital coronary abnormalities, coronary artery spasm, and coronary thrombosis due to hypercoagulable states (hereditary and acquired).


OBJECTIVE
We present a case of a young male adult with myocardial infarction caused by a combination of gene mutations and anticoagulation protein deficiency.


METHODS
A 19 years old young man was admitted to our hospital complaining of chest pain during the last two weeks. The patient did not have any known cardiovascular risk factors, except a positive family anamnesis. Subacute inferior nonST segment myocardial infarction was diagnosed according to the patient's history, electrocardiographic and laboratory findings. Coronary angiography revealed suboclusive thrombus in the proximal, medial and distal part of the right coronary artery (TIMI 2). Percutaneous coronary intervention was performed. Anticoagulant and antiagregant therapy (heparin, acetilsalicilic acid and clopidogrel) according to protocol was started. The hospital stay was uneventful. Homozygous endothelial nitric oxid synthase (eNOS) T-786-C mutation, heterozygote prothrombin gene mutation (G-20210-A), and protein S deficiency were verified from the thrombophilia testing. Other trombophilic tests were normal. Three months after discharge from hospital another coronary angiography was performed. It revealed normal coronary arteries. Four years after the attack, the patient is free of symptoms and another cardiovascular event.


CONCLUSIONS
Combination of genetic mutations and anticoagulation protein deficiency could be a reasonable cause for myocardial infarction in a very young male adult without any other cardiovascular risk factors.
Special Hospital for Surgery Diseases "Filip II", Skopje, Republic of Macedonia.
Milka
M
Klincheva
Special Hospital for Surgery Diseases "Filip II", Skopje, Republic of Macedonia.
Elena Ambarkova
EA
Vilarova
Special Hospital for Surgery Diseases "Filip II", Skopje, Republic of Macedonia.
Tanja
T
Angjusheva
Special Hospital for Surgery Diseases "Filip II", Skopje, Republic of Macedonia.
Ivan
I
Milev
Special Hospital for Surgery Diseases "Filip II", Skopje, Republic of Macedonia.
Enver
E
Idoski
Special Hospital for Surgery Diseases "Filip II", Skopje, Republic of Macedonia.
Zan
Z
Mitrev
(eNOS) T-786C mutation; myocardial infarction; protein S deficiency; prothrombin gene mutation (G-20210-A); young male