Published on:
    Journal of Cardiovascular Disease Research, 2012; 3(2):167-169
    CLINICAL CASE REPORT BASED STUDY | doi:10.4103/0975-3583.95377

    ST segment elevation myocardial infarction as a presenting feature of thrombotic thrombocytopenic purpura

    Authors:

    Auras R. Atreya1, Sonali Arora1, Senthil K. Sivalingam1,2, Gregory R. Giugliano1,2

    Department of 1Internal Medicine,

    2Division of Cardiovascular Medicine, Baystate Medical Center/Tufts University School of Medicine, Massachusetts, USA.

    Abstract:

    Myocardial infarction with ST segment elevation (STE) on electrocardiography (ECG) is a common presentation in emergency rooms across the world. Myocardial injury and necrosis are infrequently the initial presentation in patients with thrombotic thrombocytopenic purpura (TTP). A 48-year-old woman presented with STE myocardial infarction from outside hospital for primary percutaneous coronary intervention. However, her clinical picture was not consistent. Rapid evaluation revealed symptoms associated with microangiopathic hemolytic anemia, thrombocytopenia, acute kidney injury with waxing and waning mental status. A diagnosis of TTP was made with low ADAMST-13 activity. Plasmapheresis was initiated along with intravenous steroid therapy. The patient had a full recovery and went home after full recovery of left ventricular ejection fraction and normal myocardial perfusion studies. Rapid evaluation is needed to identify infrequent causes of STE myocardial infarction. As swift protocols are activated in the emergency room and catheterization laboratories to ensure quality control, it is equally important to integrate all aspects of the patient's clinical and objective data to detect unusual disease entities.

    Key words: Acute coronary syndrome, electrocardiography, microangiopathy, plasmapheresis, ST segment elevation myocardial infarction, thrombotic thrombocytopenic purpura.