Chonnam Med J.  2009 Aug;45(2):127-131. 10.4068/cmj.2009.45.2.127.

A Case of Acute Myocardial Infarction and Cerebral Infarction Associated with Metastatic Pancreatic Carcinoma

Affiliations
  • 1Department of Cardiovascular Medicine, KyungHee University Medical Center, Seoul, Korea. mylovekw@hanmail.net
  • 2Cardiovascular Center, Gwangju Veterance Hospital, Gwangju, Korea.
  • 3Department of Internal Medicine, Yeosu Chonnam Hospital, Yeosu, Korea.

Abstract

Acute myocardial infarction without angiographic evidence of arteriosclerosis is uncommon. We report the case of a 63-year-old female patient with acute myocardial infarction. Coronary angiography showed thrombotic total occlusion in the mid left anterior descending artery and thrombotic critical stenosis in the proximal left circumflex artery. Despite multiple balloon angioplasty and aspiration of thrombi, distal flow in the left anterior descending and left circumflex arteries only improved slightly, because abundant thrombi remained. No residual stenosis was observed on angiography. However, computed tomography of the abdomen showed a 5-cm low-attenuated mass with a peripheral enhanced rim in the pancreas and a maximal 7-cm multiple ill-defined peripheral enhanced low-attenuated mass in the liver. Unfortunately, the patient experienced multiple embolic cerebral infarctions 7 days later. The patient had no relevant cardiovascular disease risk factors, signs of heart failure, or arrhythmia. We believe that the pathogenetic mechanism responsible for myocardial infarction in this patient was in situ thrombosis.

Keyword

Acute myocardial infarction; Cancer; Thrombosis

MeSH Terms

Abdomen
Angiography
Angioplasty, Balloon
Arrhythmias, Cardiac
Arteries
Arteriosclerosis
Cardiovascular Diseases
Cerebral Infarction
Constriction, Pathologic
Coronary Angiography
Female
Heart Failure
Humans
Liver
Middle Aged
Myocardial Infarction
Pancreas
Pancreatic Neoplasms
Risk Factors
Thrombosis
Pancreatic Neoplasms

Figure

  • Fig. 1 Electrocardiography showed extensive ST elevation in V2 to V6 and I, aVL and marked T inversion in III, aVF compatible with acute anterolateral myocardial infarction.

  • Fig. 2 Coronary angiogram (CAG) via right transradial approach showed thrombotic total occlusion in midddle left anterior descending artery (LAD) with poor collateral circulation (A) and large thrombotic burden in proximal left circumflex artery (LCX) birfucation site (B). After successful wiring, POBA (plain old balloon angioplasty) was performed using 2.0 mm and 3.0mm sized balloon catheter for LAD and LCX several times. And, aspiration of thrombi using Thrombuster suction device was performed many times (C). Final CAG showed markedly improved flow of LAD and LCX, but distal embolic occlusions in LAD, LCX, and OM (Obtuse marginal) branch were observed (D,E). Small amount thrombi were aspirated by suction catheter (F).

  • Fig. 3 Computed Tomography (CT) scan of abdomen showed enlarged body and tail of pancreas with 5×5cm sized heterogenous soft tissue mass with multiple lymph node enlargement (A) and multiple metastatic mass (maximum 7 cm sized) in liver (B).

  • Fig. 4 Axial T2WI (T2-weighted imaging) MR (Magetic Resonance) image (Fast spin echo;FLAIR=Fast fluid-attenuated inversion-recovery) showed Increased signal intensity in left parietal and right occipital lobe (A), and Axial DWI (Diffusion-weighted) MR showed diffusion restriction in the same areas (B).


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