Myocardial infarction in a patient with β‐thalassemia major: First report

Abstract

Thalassemia is the most common hereditary anemia throughout the world. Survival in its most severe long-term form, b-thalassemia major, has significantly risen in the last decades. Cardiac morbidity-heart failure and dysrhythmias-is still the most common cause of mortality in these patients. We describe herein a case of myocardial infarction with normal coronary arteries in a 48-year-old patient with b-thalassemia and no other recognized risk factors for coronary artery disease. Thromboembolic phenomena, a known situation in these patients, occur at a frequency of 4-5%. However, as far as we know, this is the first report in the literature of myocardial infarction in association with b-thalassemia. With the notable improvement in the life expectancy of thalassemia patients, ischemic heart disease may become an important complication encountered in these patients. Am.

Subclinical Atherosclerosis In Young β-thalassemia Major Patients

“…Limited data exist on the atherogenic risk in b-TM. The first documented case of myocardial infarction in a 48-year-old patient with b-TM was reported by Fridlnder and Rund (31). They reported that endothelial dysfunction acts in combination with arterial stiffening to amplify the risk of premature atherosclerosis in b-TM.…”

Premature Atherosclerosis in Non-Transfusion-Dependent β-Thalassemia Intermedia

“…Despite phenotypic differences between patients with β-TI and β-thalassemia major, which include blood transfusion requirements and features of cardiac complications, vascular disease is relatively common in both thalassemia phenotypes and appears to have a concordant pattern in that both patient groups are protected from coronary artery disease but prone to strokes, thromboembolism, or both [1,2,3,4]. In general, however, the cardiovascular risk profile of patients with β-TI has been inadequately investigated [1].…”

“…However, a differential protection of the coronary arterial bed by very low plasma LDL levels in concert with other (e.g. micro-erythrocyte or rheological) factors is possible [2,3,4]. The surprisingly low incidence of coronary events in view of the high incidence of noncoronary events may thus reflect a magnification of existing differences between carotid and coronary artery disease in terms of the histopathophysiology and impact of serum cholesterol levels [13,14].…”

“…The remarkably high incidence of thromboembolic events and strokes in these patients while the coronary artery bed appears to be spared suggests a distinct interplay of an atheroprotective lipid pattern with a proatherogenic environment [2,3,4]. In fact, multiple clot-promoting and proinflammatory disturbances have been demonstrated in patients with β-TI and have been linked with endothelial activation, hemolysis, procoagulant erythrocytes, iron overload, arterial elastic tissue injury, oxidative stress, hyperplastic bone marrow, and splenectomy [1,5,6].…”

Risk of coronary artery disease in transfusion-naïve thalassemia populations: A nationwide population-based retrospective cohort study

“…Transfusion-dependent and transfusion-related chronic complications are typically found in the thalassemia major genotype, regardless of whether the thalassemia is α or β. In a previous study, myocardial infarction and coronary artery disease are established complications in transfusion dependent thalassemia patients like α/β thalassemia major or intermedia with more severity clinical manifestations, and thalassemia-related hemolytic anemia or hypercoagulative states are possible explanations [3][4][5].…”