Myocardial Infarction as the Initial Presentation for Fibromuscular Dysplasia

Mohammed Al-Sadawi¹, Ayman Battisha², Bader Madoukh³, Naseem A. Hossain¹, Khaleda Akter¹, Shakil Shaikh¹, Sayed Mahdi Ayat¹, Felix Nwamaghinna¹ and Samy I. McFarlane^1,

¹Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, New York, United States- 11203

²Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, United States- 01199

³Department of Internal Medicine, Overland Park Regional Medical Center-HCA Midwest Health, Overland Park, Kansas, United States- 66215

Cite this paper:
Mohammed Al-Sadawi, Ayman Battisha, Bader Madoukh, Naseem A. Hossain, Khaleda Akter, Shakil Shaikh, Sayed Mahdi Ayat, Felix Nwamaghinna and Samy I. McFarlane. Myocardial Infarction as the Initial Presentation for Fibromuscular Dysplasia. American Journal of Medical Case Reports. 2020; 8(7):166-172. doi: 10.12691/ajmcr-8-7-2

Abstract

Background: Fibromuscular dysplasia (FMD) is a non-atherosclerotic disease that affects medium-sized arteries and results in stenosis, dissection, aneurysm or occlusion. It is most commonly reported in the renal and carotid arteries. Involvement of coronary arteries is quite rare and and leads to serious consequences. Case: A 62-year-old African American woman with a history of mitral valve prolapse presented with chest discomfort associated with diaphoresis. Her EKG initially showed ST segment changes in leads II, III, and V2-V5 which resolved in approximately 30 minutes. Her troponin peaked to 20 ng/L during her hospital course. A bedside echocardiogram revealed an EF of 45% with mid, distal septal and apical hypokinesis. Decision-making: The patient was admitted to the Cardiac Care Unit for treatment of an NSTEMI. She underwent cardiac catheterization, which revealed single-vessel coronary disease with diffuse narrowing of the distal LAD, beyond the first diagonal branch down to the apex. CT angiography of her abdomen and pelvis showed mild narrowing of the mid-right renal artery with a small fusiform aneurysm measuring approximately 5 mm. Her carotid duplex showed tortuosity in the right internal carotid artery. Given the multiple vascular anomalies, a diagnosis of fibromuscular dysplasia was considered. Conclusion: Acute coronary syndrome in fibromuscular dysplasia requires an integrated approach to management, especially if there is associated malignant hypertension and/or dissection.

Keywords:
acute coronary syndrome fibromuscular dysplasia myocardial infarction

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