Acute myocardial infarction in the presence of normal coronaries and the absence of risk factors in a young, lifelong regular exerciser

Abstract

Around 6% of patients suffering an acute myocardial infarction (AMI) have normal coronary arteries. The mechanisms responsible are not fully known, but include hypercoagulable state, coronary endothelial dysfunction, aortic dissection, inflammation, coronary thrombosis, aortic wall stiffening, cocaine abuse, carbon monoxide poisoning and paradoxical embolism. Here, the case of a lifelong regular exerciser without risk factors for cardiovascular disease who suffered an AMI with normal coronaries is reported. Despite normal cardiac function on left ventriculography and echocardiography, late gadolinium enhancement by cardiac magnetic resonance (CMR) revealed significant cardiac necrosis. The long-term prognosis is favourable with low rates of coronary morbidity and mortality. Acute chest pain should not be considered as benign and warrants medical investigation.

Figure 1

Late gadolinium enhanced cardiac magnetic resonance (CMR) demonstrating inferior wall infarction extending from the base to the apex of the left ventricle (LV) (white areas indicated by arrows).

Figure 2

Bullseye plot representing the distribution of scar tissue in the left ventricle (LV). Plot demonstrates 21.7 g of scar tissue (16% of total LV mass) concentrated in the inferior LV wall.