Gómez-Montañeza E, Rojas-Salazara YL, Rojas-Salazara JG

Language: Spanish
References: 15
Page: 17-22
PDF size: 222.78 Kb.

ABSTRACT

Introduction: ST-segment elevation acute myocardial infarction (STEMI) continues to be one of the main causes of cardiovascular mortality, even in the era of early percutaneous reperfusion; and although traditional risk factors are well known, there are uncommon complications such as arrhythmic debut or early formation of intracavitary thrombi, which modify the prognosis and management.
Case report: A 55-year-old male, resident of Ciudad Juárez, with a history of myocardial infarction 12 years ago and active smoking, who suddenly started with oppressive chest pain, accompanied by syncope and nonsustained ventricular tachycardia, is presented. The electrocardiogram showed extensive anterolateral STEMI and the transthoracic echocardiogram revealed anteroseptal and apical akinesia with an ejection fraction of 36% and an apical mural thrombus of 1.5 cm. During hospital evolution he presented recurrent polymorphic ventricular tachycardia that required amiodarone and oral anticoagulation plus dual antiplatelet therapy was instituted and the patient was discharged stable on the fifth day.
Discussion: This case illustrates an infrequent combination of STEMI with ventricular arrhythmia and early intracavitary thrombus. The finding forced individualized therapeutic strategies, highlighting the importance of early reperfusion and multidisciplinary management; likewise, it emphasizes that factors such as low HDL and active smoking can have a decisive prognostic weight, even with normal LDL and total cholesterol.

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