Department of Cardiology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco.
Department of Virology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco.
J Med Case Rep. 2024 Sep 13;18(1):447. doi: 10.1186/s13256-024-04776-w.
Elevated susceptibility to acute myocardial infarction and various cardiovascular diseases has been observed in individuals infected with the human immunodeficiency virus compared with the uninfected population, as demonstrated in numerous studies. The precise mechanism by which human immunodeficiency virus infection heightens the risk of acute myocardial infarction remains elusive. The manifestation of acute coronary syndrome in young patients with human immunodeficiency virus may deviate from the typical, displaying distinct pathophysiological and clinical characteristics. The occurrence of myocardial infarction with non-obstructive coronary arteries in young patients with human immunodeficiency virus poses diagnostic and treatment challenges.
We present the case of a 46-year-old African woman with no traditional atherosclerotic risk factors. She was diagnosed with human immunodeficiency virus-1 infection 2 years prior to her current admission for chest pain. Her troponin levels were elevated, suggestive of acute coronary syndrome. Although coronary angiography ruled out coronary artery stenosis, it revealed mild myocardial bridging in the left anterior descending artery. Cardiac magnetic resonance imaging confirmed myocardial infarction, indicating a myocardial infarction with non-obstructive coronary arteries with an apical thrombus in the left ventricle. Following medical treatment, the patient experienced resolution of chest pain and improvement in ST-segment elevation.
In young female patients without traditional risk factors, human immunodeficiency virus infection is a possible etiological factor for myocardial infarction with non-obstructive coronary arteries. The likely pathophysiological pathway is superficial endothelial cell denudation as a result of chronic inflammation and immune activation.
多项研究表明，与未感染人群相比，人类免疫缺陷病毒感染者急性心肌梗死和各种心血管疾病的易感性增加。人类免疫缺陷病毒感染如何增加急性心肌梗死的风险，其确切机制仍不清楚。人类免疫缺陷病毒感染的年轻患者的急性冠状动脉综合征表现可能与典型表现不同，具有明显的病理生理和临床特征。人类免疫缺陷病毒感染的年轻患者发生非阻塞性冠状动脉心肌梗死，给诊断和治疗带来挑战。
我们报告了一例 46 岁的非洲女性，无传统动脉粥样硬化危险因素。她在本次胸痛入院前 2 年被诊断为人免疫缺陷病毒 1 型感染。她的肌钙蛋白水平升高，提示急性冠状动脉综合征。尽管冠状动脉造影排除了冠状动脉狭窄，但发现左前降支有轻度心肌桥。心脏磁共振成像证实心肌梗死，提示左心室心尖部存在非阻塞性冠状动脉心肌梗死伴血栓形成。经药物治疗后，患者胸痛缓解，ST 段抬高改善。
在无传统危险因素的年轻女性患者中，人类免疫缺陷病毒感染可能是非阻塞性冠状动脉心肌梗死的病因之一。可能的病理生理途径是慢性炎症和免疫激活导致的浅层内皮细胞脱落。
