Acute coronary syndrome in a young patient with ECG presentation of acute inferior myocardial infarction and acute thrombosis of left main stem coronary artery
Introduction. The left main stem (MS) coronary artery (CA) (MSCA) thrombosis is a rare but potentially lethal manifestation of acute coronary syndrome. The standard approach in treating such patients is the primary percutaneous coronary intervention (pPCI) or CA bypass graft surgery. In some cases,...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2023-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | https://doiserbia.nb.rs/img/doi/0042-8450/2023/0042-84502300017D.pdf |
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| author | Đenić Nemanja Milovanović Branko Romanović Radoslav Stojković Siniša Hladiš Anđelko Spasić Marijan Džudović Boris Dulović Dragan Jović Zoran Obradović Slobodan |
| author_facet | Đenić Nemanja Milovanović Branko Romanović Radoslav Stojković Siniša Hladiš Anđelko Spasić Marijan Džudović Boris Dulović Dragan Jović Zoran Obradović Slobodan |
| author_sort | Đenić Nemanja |
| collection | DOAJ |
| description | Introduction. The left main stem (MS) coronary artery (CA) (MSCA) thrombosis is a rare but potentially lethal manifestation of acute coronary syndrome. The standard approach in treating such patients is the primary percutaneous coronary intervention (pPCI) or CA bypass graft surgery. In some cases, depending on the morphological appearance of the thrombus, findings and flow rates assessed on coronary angiography (CAn), clinical conditions, and cardiologist’s experiences, another possible method of treatment can be the conservative approach using antithrombotic therapy. Case report. A 37-year-old male was admitted to the emergency room with symptoms of an acute myocardial infarction with an ST elevation in diaphragmal localization. Using an emergency CAn, we have visualized a thrombus at the ostial and proximal part of the left MSCA, with no complete obstruction of the blood flow. Initially, dual antithrombotic therapy (ticagrelor and acetylsalicylic acid) was applied, and in the further procedure, it was decided to introduce glycoprotein IIb/IIIa platelet receptor inhibitor (tirofiban) as an intracoronary bolus (0.3 μg/kg) and later as a continuous infusion (0.1 μg/kg/min). Four days later, a control CAn and intravascular echocardiography were performed, and it was decided to continue the treatment using conservative therapy without a pPCI procedure. The patient was discharged in good condition with no signs of illness on the eighth day after hospital admission for home recovery, with planned frequent follow-ups in the future. Conclusion. In the case of non-obstructive thrombotic masses without significant atherosclerotic stenotic lesions, conservative treatment modality with the use of aggressive antithrombotic therapy may be considered. |
| format | Article |
| id | doaj-art-5694c2baa6124debb701482977a760ee |
| institution | OA Journals |
| issn | 0042-8450 2406-0720 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-5694c2baa6124debb701482977a760ee2025-08-20T01:57:20ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502406-07202023-01-01801087587910.2298/VSP210428017D0042-84502300017DAcute coronary syndrome in a young patient with ECG presentation of acute inferior myocardial infarction and acute thrombosis of left main stem coronary arteryĐenić Nemanja0Milovanović Branko1Romanović Radoslav2Stojković Siniša3https://orcid.org/0000-0002-5784-9377Hladiš Anđelko4Spasić Marijan5Džudović Boris6https://orcid.org/0000-0001-9665-6052Dulović Dragan7Jović Zoran8https://orcid.org/0000-0002-9772-9062Obradović Slobodan9https://orcid.org/0000-0001-5711-5851Military Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, SerbiaMilitary Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, SerbiaMilitary Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, SerbiaUniversity Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, SerbiaMilitary Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, SerbiaMilitary Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, SerbiaMilitary Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, SerbiaMilitary Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, SerbiaMilitary Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, SerbiaMilitary Medical Academy, Clinic for Emergency Internal Medicine, Belgrade, Serbia + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, SerbiaIntroduction. The left main stem (MS) coronary artery (CA) (MSCA) thrombosis is a rare but potentially lethal manifestation of acute coronary syndrome. The standard approach in treating such patients is the primary percutaneous coronary intervention (pPCI) or CA bypass graft surgery. In some cases, depending on the morphological appearance of the thrombus, findings and flow rates assessed on coronary angiography (CAn), clinical conditions, and cardiologist’s experiences, another possible method of treatment can be the conservative approach using antithrombotic therapy. Case report. A 37-year-old male was admitted to the emergency room with symptoms of an acute myocardial infarction with an ST elevation in diaphragmal localization. Using an emergency CAn, we have visualized a thrombus at the ostial and proximal part of the left MSCA, with no complete obstruction of the blood flow. Initially, dual antithrombotic therapy (ticagrelor and acetylsalicylic acid) was applied, and in the further procedure, it was decided to introduce glycoprotein IIb/IIIa platelet receptor inhibitor (tirofiban) as an intracoronary bolus (0.3 μg/kg) and later as a continuous infusion (0.1 μg/kg/min). Four days later, a control CAn and intravascular echocardiography were performed, and it was decided to continue the treatment using conservative therapy without a pPCI procedure. The patient was discharged in good condition with no signs of illness on the eighth day after hospital admission for home recovery, with planned frequent follow-ups in the future. Conclusion. In the case of non-obstructive thrombotic masses without significant atherosclerotic stenotic lesions, conservative treatment modality with the use of aggressive antithrombotic therapy may be considered.https://doiserbia.nb.rs/img/doi/0042-8450/2023/0042-84502300017D.pdfcoronary artery diseasecoronary vesselsmyocardial infarctionplatelet aggregation inhibitorstreatment outcome |
| spellingShingle | Đenić Nemanja Milovanović Branko Romanović Radoslav Stojković Siniša Hladiš Anđelko Spasić Marijan Džudović Boris Dulović Dragan Jović Zoran Obradović Slobodan Acute coronary syndrome in a young patient with ECG presentation of acute inferior myocardial infarction and acute thrombosis of left main stem coronary artery Vojnosanitetski Pregled coronary artery disease coronary vessels myocardial infarction platelet aggregation inhibitors treatment outcome |
| title | Acute coronary syndrome in a young patient with ECG presentation of acute inferior myocardial infarction and acute thrombosis of left main stem coronary artery |
| title_full | Acute coronary syndrome in a young patient with ECG presentation of acute inferior myocardial infarction and acute thrombosis of left main stem coronary artery |
| title_fullStr | Acute coronary syndrome in a young patient with ECG presentation of acute inferior myocardial infarction and acute thrombosis of left main stem coronary artery |
| title_full_unstemmed | Acute coronary syndrome in a young patient with ECG presentation of acute inferior myocardial infarction and acute thrombosis of left main stem coronary artery |
| title_short | Acute coronary syndrome in a young patient with ECG presentation of acute inferior myocardial infarction and acute thrombosis of left main stem coronary artery |
| title_sort | acute coronary syndrome in a young patient with ecg presentation of acute inferior myocardial infarction and acute thrombosis of left main stem coronary artery |
| topic | coronary artery disease coronary vessels myocardial infarction platelet aggregation inhibitors treatment outcome |
| url | https://doiserbia.nb.rs/img/doi/0042-8450/2023/0042-84502300017D.pdf |
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