Case Report: Recurrent acute myocardial infarction in a young woman-the importance of identifying the uncommon underlying causes

Abstract

Studies have shown that the occurrence and mortality of ischemic heart disease (IHD) in young women aged 35-54 years have increased despite improving trends globally among the general population. Common risk factors such as hypertension, hyperlipidemia, diabetes and smoking play an important role in the occurrence of IHD, but some rare causes that are easily misdiagnosed or undiagnosed should also be paid attention to. Here, we report the case of a young woman (33 years old) who suffered from recurrent acute myocardial infarction (AMI) and was ultimately diagnosed with Turner syndrome (TS) by karyotype testing. TS was identified as the cause of IHD in this patient. We then adjusted treatment strategy to include long-term estrogen-progestin therapy in addition to conventional treatment for IHD (e.g., anti-platelet, lipids-lowering). The patient has been followed up on an outpatient basis and is in good clinical condition. In this report, we highlighted the important of identifying rare causes when treating young women with IHD, and we also discussed the guideline management in such patients.

Keywords: Turner syndrome; acute myocardial infarction; ischemic heart disease; replacement therapy; young woman.

Figure 1

ECG at emergency room showed sinus rhythm with pathological Q-wave on II, III and aVF leads, and T-wave changes on V7–V9 leads (A); echocardiography revealed normal left ventricular (LV) size but reduced left ventricular systolic function (LVEF, 45%), and an akinesis segment in the apical region (size 36 × 13 mm) [(B), yellow arrows]; coronary angiography revealed chronic total occlusion of the right coronary artery (RCA) in the middle segment, and proximal occlusion near the stent in LCX, 95% stenosis in LM and [(C), red arrows]; A stent was implanted in LM-LAD (blue arrow), but the attempt to open LCX and RCA failed [(D), green arrow]. RCA, right coronary artery; LAD, left anterior descending; LM, left main; LCX, left circumflex.

Figure 2

Abdominal computed tomography (CT) showed horseshoe kidney and fused kidney [(A), red arrow], no ovarian structure was seen, and cord-like shadow of uterus was visible [(B–D), blue arrow]; cytogenetic report showing a gene karyotype of 45.X [(E), green arrow].