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A 20 year old man with severe chest pain was hospitalised for acute myocardial infarction. Coronary angiography revealed total obstruction of his right coronary artery, which was successfully recanalised by direct percutaneous transluminal coronary angioplasty (PTCA). There was also diVuse thrombi in the left coronary artery that was not recanalised by perfusion with 3000 U pro-urokinase. Anticoagulant therapy was performed after PTCA. Creatine kinase peaked one day after hospitalisation (4805 U/l). The activated partial thromboplastin time was 62.6 seconds (45%). Plasma anticardiolipin IgG antibodies were high (3.8 and 2.7) in repeated examinations. The PTCA site was patent after three months. Primary antiphospholipid syndrome should be considered as a cause of acute myocardial infarction in young adults, and PTCA with anticoagulant treatment is eVective for initial treatment of the syndrome. (Heart 1998;79:96-98)

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In a 24-year-old womanwith mitochondrial encephalomyopathy presenting hypertrophic cardiomyopathy, microscopical examination of myocardial biopsy specimen disclosed severe vacuolar degeneration of myocardium and aggregates of enlarged mitochondria with proliferated cristae. Limb muscle biopsy specimen showed "ragged-red fibers" light microscopically and enlarged abnormal mitochondria with markedly increased cristae ultrastructurally.Mitochondrial DNAanalysis by polymerase chain reaction (PCR) revealed an A-to-G transition in the mitochondrial transfer RNALeu(UUR) gene at nucleotide position 3,243 which is reported to be associated with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS).However, the clinical features of this case, presenting mainly cardiac abnormalities, were not consistent with the typical MELAS. (Internal Medicine 34: 670-673, 1995)

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