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ARTICLES: John R. Lane and Giora Ben-Shachar Myocardial Infarction in Healthy Adolescents Pediatrics 2007; 120: e938-e943 [Abstract] [Full text] [PDF]

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Myocardial Infarction with normal coronary angiograms.

Edward G Abinader, Bethel Clinic, Haifa, Israel   (21 October 2007)

Myocardial Infarction with normal coronary angiograms. 21 October 2007
Edward G Abinader, Cardiologist Professor of Cardiology,Technion,, Bethel Clinic, Haifa, Israel Send letter to journal: Re: Myocardial Infarction with normal coronary angiograms. abinader{at}netvision.net.il Edward G Abinader, et al.	I read with interest the study by Lane and Ben-Shachar (1) who describe 9 otherwise healthy adolescent patients, mean age 15.5 years, presenting to the emergency department with acute myocardial infarction (AMI) according to accepted criteria. 8 of 9 were males and all had normal coronary angiograms done in all except one, after resolution of chest pains. No coronary thrombi were found. Of note was the fact that all had inferior or inferolateral infarctions. No congenital or acquired diseases were revealed including normal coagulation workup and absence of any drug abuse. Followup after hospital discharge showed no recurrence of anginal pains while on Diltiazem. In 1993 (2) we reported our experience in the study of a series of young patients, all males, admitted with acute inferior wall myocardial infarction preceded by clinically symptomatic pharyngitis and upper respiratory complaints within a period of 7 days prior to admission. In contrast to the high prevalence of anterior location of the infarction in young patients without coronary disease (3), our patients with preceding infection and AMI and normal coronary arteries demonstrated a predeliction to inferior location of AMI in young males similar to the patient population described by the authors (1). Our patients had minimal or no coronary risk factors and their prognosis was good. Although our patient population was older, as we provide adult cardiology services, the similarity regarding gender distribution and clinical characteristics incuding the site of AMI is striking. More recently Smeeth et al (4) have shown a significant increase in the risk of AMI or stroke days after an acute infection. The latter may induce endothelial dysfunction and platelet activation. It will be very informative if the authors can provide data concerning history taking regarding acute infections in the week preceding the AMI and whether C-reactive protein measurements are available. Our conclusions then were very similar to their present ones in that AMI can occur at any age and suggestive chest pains should be investigated fully including an electrocardiogram and enzymes workup. Moreover, acute infections preceding the onset of chest pain particularly in young males should alert the physician as to the possibility of AMI. We are at a stage where it is justified that queries about acute infections preceding AMI should be mandatory and part of routine history taking, particularly in younger age groups(5). The clinical and medicolegal implications are obvious. REFERENCES 1. Lane RJ, Ben-Shachar G. Myocardial infarction in healthy adolescents. J Pediatr. 2007;120(4):e938-e943 2. Abinader EG, Sharif DS, Omary M. Inferior wall myocardial infarction preceded by acute exudative pharyngitis in young males. Isr J Med Sci. 1993;29:764- 769 3. Gohlke H, Roskamm H. Myocardial infarction at young age. A challenge for primary prevention. Heart Beat 1985;3:1-3 4. Smeeth L, Thomas SL, Hall AJ, et al. Risk of myocardial infarction and stroke after infection or vaccination. N Engl J Med 2005;351:2611-2618 5. Abinader EG. Acute myocardial infarction and angiographically normal coronary arteries. Am J Cardiol. 2005;96(12):1755 Conflict of Interest: None declared

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