Acute myocardial infarction in the neonatal period

Abstract

We describe two neonates presenting with myocardial infarction, due to two different aetiologies of this extremely rare but potentially treatable condition, and discuss the management. One neonate had myocardial infarction complicating enteroviral myocarditis and recovered completely. The second had fatal myocardial infarction due to thrombosis of the left coronary artery. Although rare, the attending paediatrician should have a high index of suspicion when evaluating a neonate with acute onset of collapse. Electrocardiographic changes are diagnostic, but further echocardiographic assessment and prompt management at a tertiary cardiac centre are advised.

Neonatal Myocardial Infarction: Case Report and Review of the Literature

“…Murugan et al. reported two cases of myocardial infarction in neonates 6 . The presumed mechanism for ischemia in the patient who made complete recovery was viral myocarditis.…”

“…The experience with treatment of infants who have sustained myocardial infarction in the setting of anomalous left coronary from the pulmonary artery (ALCAPA) has generally guided therapy in the rare cases thus reported 1,2 . In reports of neonatal myocardial infarction, therapy has consisted of inotropes, diuretics, angiotensin converting enzyme (ACE) inhibitors, and, sometimes, thrombolysis 3–7 . Many etiologies for neonatal myocardial infarction have been suggested in the literature, including central line placement, myocarditis, hypercoagulability, and obstructive congenital heart disease 7–13 .…”

Functional Recovery of a Human Neonatal Heart After Severe Myocardial Infarction

“…Of note, a few case reports have been published describing patients having MI in the neonatal period without structural heart disease. [26][27][28][29][30][31][32] All reported newborns with documented MI that survived the acute phase apparently recovered their heart function. [26][27][28]31,32 Because reperfusion therapy was successfully performed in our patient, we cannot exclude the phenomena of stunning or hibernation contributing to the profound cardiac improvements in our patient.…”

Neonatal myocardial infarction due to thrombotic occlusion

“…The sudden onset of symptoms indicated an embolism as an underlying cause of infarction. The prognosis of neonatal myocardial infarction is poor, but recently some babies have survived myocardial infarction following intensive cardiac support [2,4,5] or extracorporeal membrane oxygenation [6,7]. Early recognition of neonatal myocardial infarction and aggressive cardiac support can help babies survive after myocardial infarction.…”

“…Neonatal myocardial infarction is rare and its prognosis is poor [1,2]. However, early diagnosis and intensive support can help the baby survive.…”