Trombose arterial recorrente em paciente com doença de Fabry: relato de caso

Moraes, Altino Ono; Zubiolo, Tiago Francisco Meleiro; Brito, Augusto Felipe Bruchez; Belentani, Jessica; Santos, Juliano Fabrício; Santos, Gisele Nayara Dos; Faccin, Lóren Fontinhas; Silva, Luanna Gabarrão

doi:10.1590/1677-5449.190096

Cited by 1 publication

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References 7 publications

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Section: Discussionmentioning

confidence: 99%

“…Patients with FD have risk of clinically relevant thromboembolic events, which occur at an incidence rate of 15%, including arterial thrombosis, deep vein thrombosis, and pulmonary embolism, which can be aggravated by concurrent factor V Leiden. [7,8] However, LVT is rarely observed in FD. [9] LVT is a common complication of myocardial infarction and can also occur because of hypertrophic cardiomyopathies, nonischemic dilated cardiomyopathies, and malignancies, among other causes.…”

Section: Zhou Et Al Medicine (2022) 101:21 Medicinementioning

confidence: 99%

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Fabry disease with acute myocardial infarction, left ventricular thrombosis, and pericardial effusion

Zhou

Wang

et al. 2022

Medicine

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Rationale: Fabry disease (FD) is a rare, X-linked lysosomal deposition disease characterized by multi-system symptoms. The accumulation of globotriaosylceramide in various organs, such as the kidneys and heart, as well as the nervous system, has been speculated to be the mechanism involved in tissue damage, including vascular impairment with thrombotic events.Patient concerns: Here, we describe a 72-year-old male patient diagnosed with FD, who first presented with acute myocardial infarction, left ventricular thrombosis, and pericardial effusion, accompanied by cardiac hypertrophy.Diagnoses: A physical examination showed that he was hemodynamically stable and an electrocardiogram showed ventricular tachycardia (Fig. 1A). The single obvious abnormality was an ST segment depression with a preterminal negative T wave in leads I and aVL (Fig. 1B). Coronary angiography revealed regular findings (Fig. 2). Echocardiogram conducted at our hospital revealed hypertrophy, ejection fraction 40%, pericardial effusion (Fig. 3). Speckle tracking two-dimensional echocardiography strain analysis technology confirmed left ventricular thrombosis, and also revealed decreased movement of the inferior and posterior walls, the basal segment of the posterior wall was locally fibrotic (Fig. 4A and B). Further, myocardial contrast echocardiography confirmed left ventricular thrombosis (Fig. 4C). Cardiovascular magnetic resonance imaging indicated biventricular uneven hypertrophy, which was considered metabolic cardiomyopathy, with diffuse fibrosis of biventricular walls, apical thrombosis, and ischemic cardiomyopathy in the basal segment of the left ventricular lateral wall and left ventricular anterior wall (Fig. 5). Serum alphagalactosidase concentration was 0.7 nmol/h/mgPr (normal range, 29.0-64.4 nmol/h/mgPr). Subsequent genetic testing revealed that he was hemizygous for a previously reported missense mutation (c.902G>A) inexon 6 of the GLA gene, [1] which induce p. R301Q (p.Arg301Gln), confirming a diagnosis of FD (Fig. 6).Interventions: Orally administered drugs included rivaroxaban, sacubitril valsartan, beta blockers, dapagliflozin, and mineralocorticoid receptor antagonist. Cardiac resynchronization therapy with an implanted defibrillator was implemented to prevent sudden death.Outcomes: At present, he is still in follow-up and there have been no adverse events. Conclusion:Our case suggests that clinicians should consider the possibility of FD in patients with acute myocardial infarction and cardiomyopathy. A detailed analysis of subtle historical clues would help promote earlier diagnosis of FD.

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Section: Discussionmentioning

confidence: 99%