SIMULTANEOUS MANIFESTATION OF ACUTE MYOCARDIAL-INFARCTION AND NEPHROTIC SYNDROME

This report describes the simultaneous manifestation of ischemic heart disease and nephrotic syndrome in a 37-year-old woman presenting with acute anterior myocardial infarction. Symptoms of nephrotic syndrome, such as facial and peripheral edema accompanied by proteinuria and hy perlipidemia, and onset of severe retrosternal pain developed within 2 4 h. Coronary angiography revealed a complete thrombotic occlusion of the proximal portion of the left anterior descending artery with no ev idence of arteriosclelotic lesions. Histologic examination of renal bi opsy, including electron microscopy, revealed evidence of minimal chan ge glomerulonephritis. Ultrastructural studies demonstrated widespread effacement of epithelial foot processes. Elevated levels of circulati ng fibrinogen appeared to be an important factor for the hypercoagulab le state in this patient, suggesting a causative relationship between coronary thrombosis and nephrotic syndrome.