Massive nonatherosclerotic myocardial infarction in sickle cell anemia.

A 30-year-old black man with proven sickle cell anemia died after five years of progressive heart failure and three clinically distinct episodes of myocardial infarction. Autopsy revealed massive ventricular myocardial fibrosis, a large left ventricular aneurysm, and an organized nonatherosclerotic thrombosis of the left coronary artery. Myocardial infarction, unassociated with atherosclerosis, has very rarely been reported in sickle cell anemia. A toxic/lethal level of amitriptyline was found at autopsy.