Haboub Meryem, Atlas Ilyas, Drighil Abdenasser, Habbal Rachida
Cardiology Department, University Hospital Ibn Rochd, 8, street Lahcen El Arjoun, 20100 Casablanca, Morocco.
Eur Heart J Case Rep. 2025 Jun 24;9(7):ytaf296. doi: 10.1093/ehjcr/ytaf296. eCollection 2025 Jul.
Anti-phospholipid syndrome is characterized by venous and/or arterial thrombosis in the presence of anti-phospholipid antibodies. We report a rare and dramatic manifestation of the syndrome: thrombotic coronary occlusion leading to myocardial infarction, resulting in multiple intra-LV thrombi responsible for multisystemic embolization.
We report the case of a 38-year-old Caucasian woman, who presented to the emergency department with acute chest pain. On initial clinical examination, the patient was tachycardiac at 123 b.p.m. with a correct blood pressure of 127/69 mmHg. The electrocardiogram showed sinus tachycardia at 125 b.p.m. with QS waves in the anteroseptal with persistent ST-segment elevation in the same territory. Transthoracic echocardiography revealed left ventricle ejection fraction of 35% with several intra-left ventricular (LV) thrombi. Troponin Ic was elevated at 5668 ng/L. The diagnosis of myocardial infarction was suspected and the patient was treated as such. Eight hours after admission, the patient presented with an embolization to both common femoral arteries which was treated by Fogarty embolectomy. The patient underwent coronary angiography, which revealed thrombotic occlusion of the proximal left anterior descending artery. A cerebro-thoraco-abdomino-pelvic computed tomography scan found a right renal infarct and a splenic infarct. Lab tests revealed positive anti-cardiolipin antibodies. Anti-phospholipid syndrome was confirmed and the patient was treated using aspirin and vitamin K antagonists. The evolution was marked by complete resolution of LV thrombi and the patient is actually asymptomatic apart from a slight exertional dyspnoea.
Anti-phospholipid syndrome is an autoimmune disorder whose complications can be life-threatening and/or functionally disabling. Arterial thrombosis can cause dramatic complications.
抗磷脂综合征的特征是在存在抗磷脂抗体的情况下发生静脉和/或动脉血栓形成。我们报告了该综合征一种罕见且严重的表现：血栓性冠状动脉闭塞导致心肌梗死，进而形成多个左心室内血栓，引发多系统栓塞。
我们报告了一名38岁白种女性的病例，她因急性胸痛被送往急诊科。初次临床检查时，患者心率过速，为123次/分钟，血压正常，为127/69 mmHg。心电图显示窦性心动过速，心率为125次/分钟，前间隔导联出现QS波，同一区域ST段持续抬高。经胸超声心动图显示左心室射血分数为35%，左心室内有多个血栓。肌钙蛋白Ic升高至5668 ng/L。怀疑为心肌梗死，并对患者进行了相应治疗。入院8小时后，患者双侧股总动脉出现栓塞，通过Fogarty取栓术进行了治疗。患者接受了冠状动脉造影，结果显示左前降支近端血栓性闭塞。脑胸腹盆腔计算机断层扫描发现右肾梗死和脾梗死。实验室检查显示抗心磷脂抗体阳性。抗磷脂综合征得到确诊，患者接受了阿司匹林和维生素K拮抗剂治疗。病情演变表现为左心室血栓完全消退，除轻微运动性呼吸困难外，患者目前无症状。
抗磷脂综合征是一种自身免疫性疾病，其并发症可能危及生命和/或导致功能残疾。动脉血栓形成可引起严重并发症。
