# An ST elevation myocardial infarction with multisystemic embolization: a shocking and striking first presentation of antiphospholipid syndrome: a case report

## TL;DR

A 38-year-old woman presented with a severe heart attack and multiple blood clots, later diagnosed as a rare case of antiphospholipid syndrome.

## Contribution

This case report highlights a rare and dramatic first presentation of antiphospholipid syndrome involving myocardial infarction and multisystemic embolization.

## Key findings

- The patient had thrombotic coronary occlusion leading to myocardial infarction and multiple intra-LV thrombi.
- Embolic events affected the femoral arteries, kidneys, and spleen, confirmed by imaging and lab tests.
- Treatment with aspirin and vitamin K antagonists led to complete resolution of LV thrombi and improved symptoms.

## Abstract

Anti-phospholipid syndrome is characterized by venous and/or arterial thrombosis in the presence of anti-phospholipid antibodies. We report a rare and dramatic manifestation of the syndrome: thrombotic coronary occlusion leading to myocardial infarction, resulting in multiple intra-LV thrombi responsible for multisystemic embolization.

We report the case of a 38-year-old Caucasian woman, who presented to the emergency department with acute chest pain. On initial clinical examination, the patient was tachycardiac at 123 b.p.m. with a correct blood pressure of 127/69 mmHg. The electrocardiogram showed sinus tachycardia at 125 b.p.m. with QS waves in the anteroseptal with persistent ST-segment elevation in the same territory. Transthoracic echocardiography revealed left ventricle ejection fraction of 35% with several intra-left ventricular (LV) thrombi. Troponin Ic was elevated at 5668 ng/L. The diagnosis of myocardial infarction was suspected and the patient was treated as such. Eight hours after admission, the patient presented with an embolization to both common femoral arteries which was treated by Fogarty embolectomy. The patient underwent coronary angiography, which revealed thrombotic occlusion of the proximal left anterior descending artery. A cerebro-thoraco-abdomino-pelvic computed tomography scan found a right renal infarct and a splenic infarct. Lab tests revealed positive anti-cardiolipin antibodies. Anti-phospholipid syndrome was confirmed and the patient was treated using aspirin and vitamin K antagonists. The evolution was marked by complete resolution of LV thrombi and the patient is actually asymptomatic apart from a slight exertional dyspnoea.

Anti-phospholipid syndrome is an autoimmune disorder whose complications can be life-threatening and/or functionally disabling. Arterial thrombosis can cause dramatic complications.