Myocardial infarction in patients with systemic lupus erythematosus with normal findings from coronary arteriography and without coronary vasculitis - Case reports

The authors present the cases of two young patients, a man and a woman, who presented with myocardial infarction, in the absence of ischemic heart dis ease or stenosis of the coronary arteries. The woman was known to have syst emic lupus erythematosus (SLE) for the past 3 years (the immunoglobulin M [ IgM] anticardiolipins antibodies were positive), without a history of coron ary risk factors. Suddenly she presented with acute chest pain on rest that lasted 4 hours and culminated in anterior wall myocardial infarction. She was admitted to the coronary care unit, where no thrombolysis was given. Sh e did not have echocardiographic evidence of Libman-Sacks endocarditis, but myocardial infarction was evident at the electrocardiogram (ECG). The youn g man had SLE (the IgM anticardiolipins were absent, but he was positive fo r lupus anticoagulant antibodies), he was hyperlipidemic, was a moderate sm oker and moderately obese, and had no history of ischemic heart disease He suddenly presented with an acute myocardial infarction documented by ECG, e nzymes, and gammagraphy. In both patients, coronary angiography findings we re normal and myocardial biopsy did not show evidence of arteritis. The rel evance of these cases is the rare association of ischemic heart disease in SLE, with normal coronary arteries and without evidence of arteritis or ver rucous endocarditis.