A rare cause of myocardial infarction with non-obstructive coronary arteries—case report of ST-segment elevation myocardial infarction caused by a mediastinal mass

Gue, Ying X; Anwar, Majid; Gorog, Diana A.

doi:10.1093/ehjcr/yty008

Cited by 7 publications

(8 citation statements)

References 20 publications

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“…Gue at al. presented a case of a 44-year old patient with MINOCA due to compression of coronary arteries caused by the enlarged mediastinal lymph nodes in Hodgkin lymphoma 13 . Aggarwala et al showed the case of a 71-year-old female patient who presented with findings suggestive of an acute myocardial infarction due to extrinsic cardiac mass encasing the left circumflex and right coronary arteries (RCA), which caused compression and spasticity of the RCA 14 .…”

Section: Discussionmentioning

confidence: 99%

Giant intrapericardial lipoma: Clinical and forensic implications

et al. 2023

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Introduction. Even though lipomas are the most common benign tumors, they are rarely found in the pericardial cavity. Although histopathological benign, they can cause lifethreatening complications by rapid growth and, therefore, clinically may be considered as malignant. Case report. We present a case of an 80-year-old female who was injured during syncopial episode, when falling from standing height and later died in the hospital without an obvious cause of death. At the autopsy, a dilated and tense pericardium filling up a large part of the chest cavity was noted. A well-encapsulated soft tissue mass, 20x18x3cm in size and measuring 820 g, was visualized in the pericardial cavity. Histopathological examination revealed that the mass was lipoma and showed acute myocardial necrosis and, therefore, it was assumed that the cause of death was myocardial infarction, probably due to the compression of lipoma on coronary arteries. Conclusion. Even though intrapericardial lipomas are benign tumors, they can cause life-threatening complications and sudden cardiac death. There are numerous diagnostic methods capable of detecting intrapericardial lipomas, and with timely treatment patient can be cured.

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Section: Discussionmentioning

confidence: 99%

Giant intrapericardial lipoma: Clinical and forensic implications

et al. 2023

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“…Coronary embolization is a very uncommon complication of IE at approximately 7%. While prevalence is low, this disease carries a high short- and long-term mortality and morbidity rate and therapeutic strategies for management are controversial [ 4 , 6 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…While this embolization most commonly affects the central nervous system [ 1 ], septic embolization resulting in acute coronary syndrome has an incidence of 2.2% [ 2 ], with a significant mortality rate of approximately 64% [ 3 ]. Type one myocardial infarctions (MI), caused by acute atherothrombotic events, cause approximately 97% of myocardial infarctions [ 4 ] and have a well-defined intervention and management pathway. Type two myocardial infarctions are comprised of ischemia not due to coronary artery disease, but rather due to a mismatch in myocardial oxygen supply and demand [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Infective Endocarditis Causing Acute Myocardial Infarction

Cohen¹,

Ford²,

Situ-LaCasse³

et al. 2020

Cureus

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Endocarditis is a well-known disease, yet septic embolization resulting in myocardial infarction is much rarer and very infrequently diagnosed in the emergency department (ED). Point-of-Care-Ultrasound (POCUS) can be used to confirm clinical suspicion within minutes of patient presentation, thereby expediting patient care. We report the case of a 26-year-old female with known intravenous drug use who presented with altered mental status. Her clinical presentation prompted urgent evaluation in the ED with POCUS which showed a hyperdynamic functioning left ventricle, greater than 50% inferior vena cava collapse, and a large tricuspid valve vegetation. In light of the electrocardiogram (ECG) ST changes suggesting an acute myocardial infarction, the patient was emergently taken to the cardiac catheterization laboratory where coronary angiography revealed multiple coronary emboli. Primary diagnoses included endocarditis due to Staphylococcus , septic pulmonary embolism, and ST-elevated myocardial infarction (STEMI) due to embolic occlusion of the distal left anterior descending artery. Myocardial infarction caused by septic embolization from endocarditis is a rare condition; however, POCUS is a quick, non-invasive tool that can aid the emergency medicine (EM) physician in identifying this life-threatening pathology thereby expediting appropriate care for the patient.

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“…Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a well-documented phenomenon, with approximately 2%–3% of cardiac catheterisations revealing non-atherosclerotic coronaries 5 6. Documented causes include, but are not limited to, coronary steal, electrolyte abnormalities, coronary vasospasm, myocardial oxygen supply–demand mismatch, embolic events, coronary artery vasculitis, radiation-associated fibrosis, cocaine abuse and external compression from other thoracic structures 5 7–11. In such instances, thoracic and/or cardiac imaging may be indicated to evaluate for other aetiologies 7…”

Section: Introductionmentioning

confidence: 99%

STEMI: rare initial presentation of a mediastinal mass supplied by the RCA

et al. 2019

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In the setting of severe septic shock, a 70-year-old woman had an ST segment myocardial infarction with ST elevations in the inferolateral leads. On cardiac catheterisation, no obstructive pathology was noted. Chest imaging revealed a large mediastinal mass measuring 8.5×6.5×7.5 cm in the visceral compartment of the mediastinum, with contrast enhancement from the right coronary artery (RCA). A biopsy was preformed and cytology was consistent with a well-differentiated neuroendocrine neoplasm. On review of the cardiac catherisation, it was noted that the mass was deriving blood supply from the RCA. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare but well-documented phenomenon. In this case, MINOCA was caused by coronary steal syndrome in the setting of profound hypotension. Immediate management is with haemodynamic support; there is no role for coronary intervention.

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A rare cause of myocardial infarction with non-obstructive coronary arteries—case report of ST-segment elevation myocardial infarction caused by a mediastinal mass

Cited by 7 publications

References 20 publications

Giant intrapericardial lipoma: Clinical and forensic implications

Giant intrapericardial lipoma: Clinical and forensic implications

Infective Endocarditis Causing Acute Myocardial Infarction

STEMI: rare initial presentation of a mediastinal mass supplied by the RCA

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