A rare case of acute myocardial infarction with a non-specific symptom in a young female with systemic lupus erythematosus

Abstract

A 31-year-old female with an 18-year history of systemic lupus erythematosus (SLE) complained of epigastralgia and consulted the emergency outpatient department at our hospital. Her physical examination revealed tenderness at the scrobiculus cordis, which was a non-specific symptom of coronary heart disease (CHD). We ultimately gave a diagnosis of acute myocardial infarction based on coronary angiography and performed percutaneous coronary intervention. Although pre-interventional intravascular ultrasound demonstrated distinct atherosclerotic lesions in the coronary arteries, there were no atherosclerotic lesions in other systemic arteries. Although CHD in young SLE patients is a significant cause of morbidity and premature death, it tends to be misdiagnosed because their symptoms may be non-specific. In addition, this case highlights the fact that even SLE patients with no systemic atherosclerosis are at risk for the development of CHD. <Learning objective: Coronary heart disease (CHD) in young systemic lupus erythematosus (SLE) patients is a significant cause of morbidity and premature death, but it tends to be misdiagnosed because their symptoms may be non-specific. Moreover, SLE patients are at risk for the development of CHD.>.

Keywords: Coronary heart disease; No systemic atherosclerosis; Non-specific symptoms; Systemic lupus erythematosus.

Fig. 1

Electrocardiography on admission.

Fig. 2

Diastole (A) and systole (B) as assessed by echocardiography on admission. White arrow heads show akinesia of the left ventricular anteroseptal wall and apex. Coronary angiography showed 99% stenosis of the proximal left anterior descending coronary artery (LAD) (C, D) and an intact right coronary artery (E) on admission. White arrows show severe stenosis of the LAD, and black arrow shows collateral circulation from the right posterior descending artery to the LAD. LA, left atrium; LV, left ventricle.

Fig. 3

Intravascular ultrasound showed attenuated coronary plaque corresponding to severe stenosis.

Fig. 4

Electrocardiography (A) and echocardiography (B; diastole, C; systole) performed 1 year after discharge in the outpatient department. There was no asynergic motion of the left ventricle. The left ventricular ejection fraction was 74% using Simpson’s method.