Myocardial infarction with normal coronary arteries in a patient with primary antiphospholipid syndrome - Case report and literature review

Primary antiphospholipid syndrome is associated with an increased risk of v ascular thrombosis. The authors describe a young patient without any risk f actor for coronary artery disease who was admitted to the hospital because of a transient cerebral ischemic attack. Standard EKG showed signs of a pre vious silent inferior wall myocardial infarction, confirmed by echocardiogr aphy, technetium-99 scintigraphy, and left ventricular angiography. Coronar y arteries appeared normal at angiography. Blood tests showed the presence of antiphospholipid antibodies and lupus anticoagulant. Since there is evid ence that these antibodies are associated with an increased risk of microva scular thrombosis, the authors conclude that this silent myocardial infarct ion could be caused by a cardiac microvascular disease accompanying the ant iphospholipid syndrome.