Acute Nonatherosclerotic Coronary Thromboembolism Presenting with an Inferior STEMI in a Patient on Oral Contraception

• Type of Material: Article
• Authors: Nabil Braiteh, Wilson Regional Medical Center; Raheel Chaudhry, United Health Services Hospitals; Ibraheem Rehman, Emory University; Jowana Breiteh, American University of Beirut; Alon Yarkoni, United Health Services Hospitals
• Language: English
• Date: 2021-12-24
• Publisher: Hindawi Publishing Corporation
• Publication Version: Final Published Version
• Copyright Statement: © 2021 Nabil Braiteh et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1155/2021/5450376
• Title of Journal or Parent Work: Case Reports in Cardiology
• Volume: 2021
• Keywords: Nonatherosclerotic; Atherosclerotic coronary artery disease; STEMI
• Research Categories: Health Sciences, Nutrition; Health Sciences, Medicine and Surgery

Abstract

Background Direct coronary embolism in the setting of oral contraceptive pill (OCP) use is a rare adverse effect. It is known for OCP to increase the risk of thrombosis; however, leading to an inferior ST elevated myocardial infarction (STEMI) due to an acute occlusive embolism is a rare entity. Coronary embolism occurs in about 3% of patients with acute coronary syndrome. Case Report. We present a case of a young 41-year-old female with a past medical history significant for dysfunctional uterine bleeding on oral contraceptive pills, who presented to the hospital with chest pain. Her workup was significant for troponin elevation and an electrocardiogram showing inferior ST elevations. The patient was taken emergently to the cardiac catheterization lab. A coronary angiogram revealed a coronary thrombus involving the distal left main and proximal left anterior descending (LAD) with no evidence of atherosclerotic disease. The patient subsequently received anticoagulation therapy leading to complete resolution of symptoms and ST elevations. Conclusion Coronary embolism is rare and often not considered in the differential of acute coronary syndrome. It is of utmost importance for clinicians to keep a wide differential of nonatherosclerotic causes of STEMI especially when the patient is young, without significant cardiac risk factors.