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Case Reports
. 2023 Jun 27;15(6):e41026.
doi: 10.7759/cureus.41026. eCollection 2023 Jun.

Acute Myocardial Infarction as the First Presentation of Systemic Lupus Erythematosus in a 23-Year-Old Patient

Mohammed Ayyad  1 , Maram Albandak  1 , Mansour Khaleel  2 , Nabil C N Khalil  2 , Muaath Itmaizeh  3
Affiliations
Case Reports

Acute Myocardial Infarction as the First Presentation of Systemic Lupus Erythematosus in a 23-Year-Old Patient

Mohammed Ayyad et al. Cureus. .

Abstract

ST-segment elevation myocardial infarction (STEMI) in young adults is a rare occurrence that requires a thorough investigation to determine the underlying cause. Herein, a young female patient presented with dull retrosternal chest pain associated with nausea and left arm numbness. Cardiac-specific troponin was elevated and the electrocardiogram revealed ST-segment elevation in the inferior wall leads indicative of myocardial infarction. The patient was started on dual antiplatelet therapy (DAPT) and emergency coronary angiography was performed, revealing a 20% stenosis in the left circumflex artery and evidence of a thrombotic lesion in the posterolateral branch (PLB), which was deemed unsuitable for intervention. During the diagnostic workup, the patient tested positive for antinuclear antibodies and was ultimately diagnosed with systemic lupus erythematosus (SLE) and antiphospholipid syndrome. This case highlights the rarity of STEMI as an initial presentation of SLE. It emphasizes the importance of considering autoimmune disorders in young patients with acute myocardial infarction and the need for a comprehensive evaluation and appropriate management in such cases.

Keywords: acute coronary syndrome; anti-double-stranded dna antibodies (anti-dsdna); antinuclear antibodies (ana); atherosclerosis; autoimmune disease; dual-antiplatelet therapy (dapt); myocardial infarction; primary pci; stemi; systemic lupus erythematosus.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. 12-lead ECG findings on admission showing ST-segment elevation of the inferior leads (red arrows) accompanied by reciprocal changes (blue arrow).
Figure 2
Figure 2. Cardiac catheterization findings in our patient using the right radial approach.
The angiogram shows distal slow flow in the posterolateral branch (PLB) of the right coronary artery, indicative of possible thrombus formation (red circle). The small caliber of the vessel makes it unsuitable for immediate intervention.
See this image and copyright information in PMC

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