Author + information
- Zachary Oman,
- Tarek Ajam,
- Wei Zhang,
- Nauman Khalid and
- Tarek Helmy
Aortic thrombosis is a rare cause of acute myocardial infarction in young patients.
A 56-year-old man with 20-pack-year smoking history and hypertension presented with acute onset substernal chest pain and ST-segment elevation in inferolateral leads. Coronary angiogram revealed an acute thrombotic occlusion of the right coronary artery treated with a bare metal stent restoring coronary flow. 24-hours later, our patient developed recurrent chest pain and new ST-segment elevation. Repeat angiogram showed a recurrent thrombotic occlusion distal to the previously placed stent requiring another stent placement resulting in resolution of the arterial occlusion.
Due to recurrent myocardial infarctions, angiography with stent placement and embolic source identification were paramount. Transesophageal echocardiogram confirmed a highly mobile pedunculated mass (Image-1) in the ascending aortic wall anchored near the coronary artery ostium and progressing toward the aortic valve. Surgical wedge resection was performed to remove the mass which was found to be an organizing thrombus on histopathology.
This case highlights the challenging diagnosis of recurrent myocardial infarction and the importance of coronary angiography with embolic source identification. After surgical intervention, our patient remained symptoms free with excellent recovery.
Poster Hall, Hall A/B
Saturday, March 10, 2018, 10:00 a.m.-10:45 a.m.
Session Title: FIT Clinical Decision Making: Interventional Cardiology, Ischemic Heart Disease and Vascular Medicine
Abstract Category: Acute and Stable Ischemic Heart Disease
Presentation Number: 1108-141
- 2018 American College of Cardiology Foundation