title: Acute Myocardial Infarction Due to Coronary Artery Embolism in a 22-Year-Old Woman with Mitral Stenosis with Atrial Fibrillation Under Warfarinization: Successful Management with Anticoagulation.
abstract: BACKGROUND Coronary artery embolization is an exceedingly rare cause of myocardial infarction, but a few cases in association with prosthetic mechanical valves have been reported. We report a case of embolic myocardial infarction caused by a thrombus in the left atrium with deranged coagulation profile in a patient with critical mitral stenosis under warfarinization. CASE REPORT A 22-year-old woman was taken to the catheterization lab for early coronary intervention in lieu of non-ST elevation myocardial infarction. Electrocardiography showed T↓ in V1 to V4, and atrial fibrillation with controlled ventricular rate. Coronary angiography showed total occlusion of the mid-left anterior descending artery with thrombus. After upstream treatment with tirofiban, the apparent thrombus was dislodged distally while passing a BMW wire. No abnormalities were seen by intravascular ultrasound study. Echocardiography revealed critical mitral stenosis, and left atrial clot with mild left ventricular dysfunction. Coagulation profile revealed sub-therapeutic international normalized ratio levels. The sequential angiographic images, normal intravascular ultrasound study, and presence of atrial fibrillation are confirmatory of coronary embolism as the cause of myocardial infarction. Anticoagulation and treatment of acute coronary syndrome were initiated and she was referred for closed mitral valvulotomy. CONCLUSIONS Coronary artery thromboembolism as a nonatherosclerotic cause of acute coronary syndrome is rare. The treatment consists of aggressive anticoagulation, antiplatelet therapy, and interventional options, including simple wiring when possible. In this context, primary prevention in the form of patient education on optimal anticoagulation with oral vitamin K antagonist and medical advice about imminent thromboembolic risks are of extreme importance.
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial (G.S.V.M.) Medical College, Kanpur, India.
authors.forename: Santosh Kumar
authors.initials: SK
authors.lastname: Sinha
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial (G.S.V.M.) Medical College, Kanpur, India.
authors.forename: Mukesh Jitendra
authors.initials: MJ
authors.lastname: Jha
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial (G.S.V.M.) Medical College, Kanpur, India.
authors.forename: Mahmadula
authors.initials: M
authors.lastname: Razi
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial (G.S.V.M.) Medical College, Kanpur, India.
authors.forename: Vikash
authors.initials: V
authors.lastname: Chaturvedi
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial (G.S.V.M.) Medical College, Kanpur, India.
authors.forename: Yatish Besthenahalli
authors.initials: YB
authors.lastname: Erappa
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial (G.S.V.M.) Medical College, Kanpur, India.
authors.forename: Shravan
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial (G.S.V.M.) Medical College, Kanpur, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Mishra
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial (G.S.V.M.) Medical College, Kanpur, India.
authors.forename: Dibbendhu
authors.initials: D
authors.lastname: Khanra
authors.affiliation: Department of Cardiology, LPS Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial (G.S.V.M.) Medical College, Kanpur, India.
authors.forename: Karandeep
authors.initials: K
authors.lastname: Singh
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000209:etiology*; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications; D054059:Coronary Occlusion / Q000150:complications / Q000188:drug therapy / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D013923:Thromboembolism / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D014859:Warfarin / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014859:Warfarin