Acute myocardial infarction and extensive systemic thrombosis in thrombotic thrombocytopenic purpura: A case report and review of literature

Abstract

BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy characterized by the pentad of hemolytic anemia, fever, thrombocytopenia, renal failure, and neurological dysfunction. The formation of microthrombi in the arterioles and capillaries of various organs is one of the main pathophysiological mechanisms. Clinical manifestations of cardiac involvement in TTP patients are variable. Acute myocardial infarction has been reported as a complication with TTP as the secondary thrombotic event. Its emergence as the initial thrombotic event is extremely rare. CASE SUMMARY A 49-year-old previously healthy man was admitted for fever, typical angina chest pain 3 d prior to presentation, and newly onset left lower limb pain. The electrocardiogram illustrated ST-elevation acute myocardial infarction of the antero-lateral wall of the left ventricle. Transthoracic echocardiography depicted two large thrombi at the apex of the left ventricle and moderately reduced ejection fraction (40%). Venous Doppler ultrasound showed occlusion of the left popliteal artery. Laboratory tests showed severe thrombocytopenia, mild hemolytic anemia, elevated D-dimers, and high troponin and creatine kinase-MB. Abdominal computed tomography revealed other thrombotic sites (superior mesenteric artery, posterior aortic wall, spleen and renal infarction, and ileum necrosis). He was immediately started on steroids and addressed to surgery for acute abdominal pain. After an initial stabilization of the hematological deficit, he went into general surgery for resection of the necrotic ileum but died soon after the intervention due to multiple organ failure. CONCLUSION Cardiac involvement in TTP patients is common, challenging and more often fatal, especially when other thrombotic complications coexist.

Non-ST-Segment Elevation Myocardial Infarction As Initial Thrombotic Event of Thrombotic Thrombocytopenic Purpura: A Rare Challenging Case

“…The exact prevalence of TTP-induced MI is unknown, and the literature underlines the prevalence of TTP-induced cardiovascular complications from 9.5% to 77%. However, TTP-induced MI as presenting event of TTP is extremely rare [5]. We have tabulated the reported cases of TTP-induced cardiac events in M: male, F: female, STEMI: ST-segment elevation myocardial infarction, NSTEMI: non-ST-segment elevation myocardial infarction, ADAMTS: a disintegrin-like and metalloproteinase with thrombospondin motif, TTP: thrombotic thrombocytopenic purpura.…”

“…The exact prevalence of TTP-induced MI is unknown, and the literature underlines the prevalence of TTP-induced cardiovascular complications from 9.5% to 77%. However, TTP-induced MI as presenting event of TTP is extremely rare [ 5 ]. We have tabulated the reported cases of TTP-induced cardiac events in Table 2 [ 4 - 8 ].…”

Acute myocardial infarction in a patient with thrombotic thrombocytopenic purpura: a case report and literature review

“…AMI has been associated with TTP, with reported incidence rate varying between 15% and 41% [6,8] . Reported cases of AMI induced by TTP [4,[9][10][11][12][13][14][15][16][17][18][19][20] are summarized in Table 3. A large national database of 4,032 patients with TTP [21] reported 11.1% in-hospital mortality and 5.7% AMI rate.…”