Acute myocardial infarction

Case contributed by Dr Julian L. Wichmann


80yr old patient presents with acute chest pain, elevated cardiac enzymes but also elevated d-dimers, therefore triple-rule-out CT was performed.

Patient Data

Age: 80
Gender: Male

CT angiography

15 mg of metroprolol and 2 pumps of glycerol trinitrate were administered before the scan.

There is an occlusion of the medial segment of the RIVA resulting in an anterior wall infarction with consecutive akinesia and microvascular obstruction.

There is also stenosis of the proximal part of the diagonal branch of the RIVA.

There is infarct-related right-sided pleural effusion and alveolar edema.

DSA (angiography)

Invasive coronary angiography confirms the diagnosis and also demonstrates narrowing of the D2 branch.

Case Discussion

This case demonstrates acute myocardial infarction with resulting perfusion deficits with microvascular obstruction. Invasive coronary angiography images confirmed the diagnosis.

Triple-Rule-Out computed tomography is useful for diagnosing or ruling out the major life-threatening thoracic pathologies: aortic dissection, pulmonary embolism and myocardial infarction. Especially since d-dimer levels can be elevated due to various other reasons as malignancies, infection or leucemia.

This patient presented with chest pain but also elevated d-dimer levels and shortness of breath. The treating cardiologist already suspected acute myocardial infarction, but requested a CT scan to also rule out pulmonary embolism. After diagnosis, the patient was immediately transferred to the cath lab and multiple stents were placed.

Microvascular obstruction, which is present in this case, is known to be a significant predictor of major adverse cardiac events. Unfortunately, this was also true in this case, as the patient deceased after a week from cardiac arrest.

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Case information

rID: 23413
Published: 13th Jun 2013
Last edited: 14th Aug 2019
System: Cardiac
Inclusion in quiz mode: Included

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