Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.4040
Peer-review started: January 15, 2021
First decision: January 24, 2021
Revised: January 29, 2021
Accepted: March 23, 2021
Article in press: March 23, 2021
Published online: June 6, 2021
Atherosclerosis represents the main cause of myocardial infarction (MI); other causes such as coronary embolism, vasospasm, coronary-dissection or drug use are much rarely encountered, but should be considered in less common clinical scenarios. In young individuals without cardiovascular risk factors, the identification of the cause of MI can sometimes be found in the medical history and previous treatments undertaken.
We present the case of a 34-year-old man presenting acute inferior ST-elevation MI without classic cardiac risk factors. Seven years ago, he suffered from orchidopexy for bilateral cryptorchidism, and was recently diagnosed with right testicular seminoma for which he had to undergo surgical resection and chemotherapy with bleomycin, etoposide and cisplatin. Shortly after the first chemotherapy treatment, namely on day five, he suffered an acute MI. Angiography revealed a mild stenotic lesion at the level of the right coronary artery with suprajacent thrombus and vasospasm, with no other significant lesions on the other coronary arteries. A conservative treatment was decided upon by the cardiac team, including dual antiplatelets therapy and anticoagulants with good further evolution. The patient continued the chemotherapy treatment according to the initial plan without other cardiovascular events.
In young individuals with no cardiovascular risk factors undergoing aggressive chemotherapy, an acute MI can be caused by vascular toxicity of several anti-cancer drugs.
Core Tip: Atherosclerosis represents the main cause of acute myocardial infarction (MI), but less frequent causes should be evaluated in young individuals not at risk of such cardiac events. Aggressive chemotherapy for testicular seminoma increases vascular toxicity that may induce acute MI, complicating the clinical course of the subject. Under conservative treatment with antiplatelets and anticoagulants, the clinical evolution of subjects is favorable, but with the extant risk of repeating cardiac events on further chemotherapy courses.