Primary Antiphospholipid Antibody Syndrome Presenting as Acute Myocardial Infarction

J INVASIVE CARDIOL 2021;33(11):E918.

Key words: cardiac imaging, histopathological examination, thrombus

A 46-year-old woman with no significant past history presented to the emergency department with history of sudden-onset central chest discomfort and diaphoresis. Her electrocardiogram was suggestive of acute anterior-wall myocardial infarction (MI). Transthoracic echocardiography revealed apical hypokinesia and a hyperechoic nodular mass with irregular borders on the ventricular aspect of the posterior mitral valve leaflet (Figure 1). She had significant troponin I elevation.

With a preliminary diagnosis of acute MI, she was subjected to coronary angiography, which showed occlusion of the distal left anterior descending artery with otherwise normal epicardial coronary arteries. Aspiration was performed in the vessel and yielded pinkish friable tissue. The histopathological examination revealed fibrin-rich thrombus. The vessel regained Thrombolysis in Myocardial Infarction 3 flow. Her blood investigations were positive for antibodies for primary antiphospholipid antibody syndrome (IgM anticardiolipin antibody and lupus anticoagulant). An antinuclear antibody profile was negative. Blood cultures showed no microbial growth. The patient was treated with enoxaparin and switched to oral anticoagulation with warfarin.

On follow-up, the nodular mass on the mitral valve reduced considerably in size and she was advised that life-long anticoagulation was necessary.

From the Department of Cardiology, Meitra Hospital, Kozhikode, Kerala.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted June 4, 2021.

The authors report patient consent for the images used herein.

Address for correspondence: Jomy Vadasseril Jose, MD (General Medicine), DM (Cardiology), Junior Consultant, Department of Cardiology, Meitra Hospital, Kozhikode, Kerala, 673005 India. Email: jomy960@gmail.com