Myocardial Infarct with Non Obstructive Coronary Arteries in Young Woman with Peripartum Cardiomyopathy : A Case Report Mohamad Fatichul Huda (a*), Saniy Ghaida (b)
Program Studi Sarjana Kedokteran, Fakultas Kedokteran, Universitas Jenderal Achmad Yani, Cimahi
Abstract
Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA) in young woman is a rare case in daily. It has a five times increase in young woman incident of non atherosclerotic Mi. MINOCA for approximately 17% of coronary thrombosis in pregnancy. We report of 30 years old with Peripartum Cardiomyopathy (PPCM). She was 16 days post partum and came to Emergency Room with acute chest pain. Physical examination was elevated JVP with ronchi at basal pulmo. Electrocardiogram showed ST-segment elevation in the inferior leads while Troponin I level was elevated, suggesting diagnosis STEMI inferior. The patient is known for decreased left ventricular ejection fraction and global hypokinesia at inferior wall left ventricle. Coronary angiography showed normal coronary with thrombus Distal Left Coronary circumflex and coronary slow flow. No subsequent intervention was given. She was treated in ICU with an anticoagulant, ace-inhibitor, beta blocker, mineralocorticoid receptor antagonists, diuretic. Our case further documents thrombus coronary occlusion as a consequence of PPCM. Oxidative stress led to cleavage of the nursing hormone, prolactin. The 16-kDa prolactin fragment had vasculotoxic and pro-apoptotic properties and vascular and myocardial dysfunction. Protein C and protein S can influens hypercoaguable conditions, although infrequent, were more common with MINOCA than MI-CAD. Deficiency of protein C and protein S resulting in unchecked thrombin generation, leading to thromboembolism. Coronary thrombosis may potentially cause coronary occlusion and thus be responsible for MINOCA.
Keywords: Young woman, myocardial infarct, peripartum cardiomiopathy
