Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8104
Peer-review started: May 7, 2021
First decision: June 6, 2021
Revised: June 19, 2021
Accepted: July 27, 2021
Article in press: July 27, 2021
Published online: September 26, 2021
Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy characterized by the pentad of hemolytic anemia, fever, thrombocytopenia, renal failure, and neurological dysfunction. The formation of microthrombi in the arterioles and capillaries of various organs is one of the main pathophysiological mechanisms. Clinical manifestations of cardiac involvement in TTP patients are variable. Acute myocardial infarction has been reported as a complication with TTP as the secondary thrombotic event. Its emergence as the initial thrombotic event is extremely rare.
A 49-year-old previously healthy man was admitted for fever, typical angina chest pain 3 d prior to presentation, and newly onset left lower limb pain. The electrocardiogram illustrated ST-elevation acute myocardial infarction of the antero-lateral wall of the left ventricle. Transthoracic echocardiography depicted two large thrombi at the apex of the left ventricle and moderately reduced ejection fraction (40%). Venous Doppler ultrasound showed occlusion of the left popliteal artery. Laboratory tests showed severe thrombocytopenia, mild hemolytic anemia, elevated D-dimers, and high troponin and creatine kinase-MB. Abdo
Cardiac involvement in TTP patients is common, challenging and more often fatal, especially when other thrombotic complications coexist.
Core Tip: Physicians should be vigilant regarding the possible diagnosis of thrombotic thrombocytopenic purpura when identifying multiple thrombotic sites in the context of an acute myocardial infarction associated with thrombocytopenia. At the moment of diagnosis, plasma exchange with fresh frozen plasma replacement and immunosuppression with corticosteroids should be considered. The prognosis is severe.