American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
Go
American Journal of Medical Case Reports. 2020, 8(7), 166-172
DOI: 10.12691/ajmcr-8-7-2
Open AccessCase Report

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. McFarlane1,

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

Pub. Date: April 12, 2020

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

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Olin, J. W., Froehlich, J., Gu, X., Bacharach, J. M., Eagle, K., Gray, B. H., . . . Gornik, H. L. (2012). The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients. Circulation, 125(25), 3182-3190.
 
[2]  Palubinskas A, Ripley HR: Fibromuscular hyperplasia in extrarenal arteries. Radiology 82:451, 1964.
 
[3]  Ogawa T, Nomura A, Komatsu H, et al. Fibromuscular dysplasia involving coronary arteries: a case report. Angiology 1999; 50: 153-6.
 
[4]  James TN. Morphologic characteristics and functional significance of focal fibromuscular dysplasia of small coronary arteries. Am J Cardiol 1990; 65: 12G-22G.
 
[5]  Huizar JF, Awasthi A, Kozman H. Fibromuscular dysplasia and acute myocardial infarction: evidence for a unique clinical and angiographic pattern. J Invasive Cardiol 2006; 18: E99-101.
 
[6]  Kalinskaya, A., Skrypnik, D., Kostin, A., Vasilieva, E., & Shpektor, A. (2019). Case Report of an Acute Myocardial Infarction as a Result of Spontaneous Coronary Artery Dissection in a Patient with Fibromuscular Dysplasia. Case reports in cardiology, 2019.
 
[7]  Plouin PF, Perdu J, Batide-Alanore A, Boutouyrie P, Gimenez-Roqueplo AP, Jeunemaitre X. Fibromuscular dysplasia. Orphanet J Rare Dis. 2007; 2: 28.
 
[8]  Michelis, K. C., Olin, J. W., Kadian-Dodov, D., d'Escamard, V., & Kovacic, J. C. (2014). Coronary artery manifestations of fibromuscular dysplasia. Journal of the American College of Cardiology, 64(10), 1033-1046.
 
[9]  Camuglia A,Manins V, Taylor A, et al. Case report and review: epicardial coronary artery fibromuscular dysplasia. Heart Lung Circ 2009; 18: 151-4.
 
[10]  Lie, J. T., & Berg, K. K. (1987). Isolated fibromuscular dysplasia of the coronary arteries with spontaneous dissection and myocardial infarction. Human pathology, 18(6), 654-656.
 
[11]  Poulter R, Ricci D, Saw J. Perforation during stenting of a coronary artery with morphologic changes of fibromuscular dysplasia: an unrecognized risk with percutaneous intervention. Can J Cardiol 2013; 29: 519.e1-3.
 
[12]  Pate G, Lowe R, Buller CE. Fibromuscular dysplasia of the coronary and renal arteries? Catheter Cardiovasc Interv 2005; 64: 138-45.
 
[13]  Saw J. Spontaneous coronary artery dissection. Can J Cardiol 2013; 29: 1027-33.
 
[14]  Olin JW, Gornick HL, Bacharach JM, et al., for the American Heart Association Council on Peripheral Vascular Disease; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; American Heart Association Council on Cardiovascular Disease in the Young; American Heart Association Council on Cardiovascular Radiology and Intervention; American Heart Association Council on Epidemiology and Prevention; American Heart Association Council on Functional Genomics and Translational Biology; American Heart Association Council for High Blood Pressure Research; American Heart Association Council on the Kidney in Cardiovascular Disease; American Heart Association Stroke Council. Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association. Circulation 2014; 129: 1048-78.
 
[15]  Wright RS, Anderson JL, Adams CD, et al. 2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction (Updating the 2007 Guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American College of Emergency Physicians, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 57: 1920-59.
 
[16]  Ellis CJ, Haywood GA, Monro JL. Spontaneous coronary artery dissection in a young woman resulting from an intense gymnasium “work-out”. Int J Cardiol 1994; 47: 193-4.
 
[17]  Salifu MO, Haria DM, Badero O, Aytug S, McFarlane SI. Challenges in the diagnosis and management of renal artery stenosis. Curr Hypertens Rep. 2005; 7(3): 219-27.