A CASE OF ACUTE MYOCARDIAL-INFARCTION - INTRACORONARY THROMBOSIS IN 2MAJOR CORONARY-ARTERIES DUE TO HORMONE-THERAPY

A fifty-four-year-old woman was admitted to the hospital for a sensati on of tightness in the chest of one hour's duration. She had undergone surgery for breast cancer two years previously and had been taking 30 mg of tamoxifen and 1200 mg of medroxyprogesterone daily after surger y. Emergency coronary angiography on admission revealed thrombi in bot h the right coronary artery and the left anterior descending coronary artery. Tissue-type plasminogen activator was injected into both coron ary arteries, resulting in diminution of thrombus size. Repeat coronar y angiography on the next day disclosed no thrombus in either artery a nd no significant stenosis. Electrocardiographic and laboratory data i ndicated myocardial infarction. These findings strongly suggest that t he combination hormone therapy altered the patient's blood coagulabili ty and played an important role in the formation of the intracoronary thrombi and subsequent acute myocardial infarction.