Korean Circ J.  2009 Apr;39(4):163-167. 10.4070/kcj.2009.39.4.163.

Myocardial Infarction in a Young Man due to a Hypoplastic Coronary Artery

• Sim DS
• Jeong MH
• Choi S
• Yoon NS
• Yoon HJ
• Moon JY
• Hong YJ
• Kim KH
• Park HW
• Kim JH
• Ahn Y
• Cho JG
• Park JC
• Kang JC

• KMID: 2225692
• DOI: http://doi.org/10.4070/kcj.2009.39.4.163

Abstract

Hypoplastic coronary artery disease (HCAD) is a rare condition that may lead to myocardial infarction (MI) and sudden death. We discovered HCAD in a young man who developed chest pain after heavy drinking and who was found to have suffered an MI. His ECG showed ST-segment elevation with Q waves in the anterior leads, and echocardiography revealed apical dyskinesia with moderate left ventricular (LV) dysfunction. Coronary angiography showed hypoplasia of the left anterior descending (LAD) artery. (99m)Tc-tetrofosmin-gated myocardial perfusion scintigraphy showed a large, fixed perfusion defect in the anteroseptal and apical segments. Sixty-four-slice cardiac CT and cardiac MR imaging demonstrated thinning of the apical wall with calcification and delayed enhancement, supporting the diagnosis of long-standing MI. The patient was discharged symptom-free on medication for ischemic heart failure two weeks after admission. Although HCAD is very uncommon, it should be considered in children and young adults who suffer MI or sudden cardiac death.

Keyword

Coronary vessel anomalies; Myocardial Infarction

MeSH Terms

Arteries
Chest Pain
Child
Coronary Angiography
Coronary Artery Disease
Coronary Vessel Anomalies
Coronary Vessels
Death, Sudden
Death, Sudden, Cardiac
Drinking
Dyskinesias
Echocardiography
Electrocardiography
Heart Failure
Humans
Myocardial Infarction
Perfusion
Perfusion Imaging
Young Adult

Figure

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  Fig. 1 ECG on admission showing ST-segment elevation and Q waves in the anterior precordial leads. ECG: electrocardiogram.

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  Fig. 2 Left coronary artery angiograms showing a hypoplastic mid-to-distal left anterior descending coronary artery (arrows). A: left anterior oblique view. B: right anterior oblique view.

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  Fig. 3 Right coronary artery angiograms showing right dominant coronary artery circulation, with a posterior descending artery supplying the inferior aspect of the interventricular septum. A: left anterior oblique view. B: right anterior oblique view.

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  Fig. 4 Left anterior oblique view of the left coronary artery showing hypoplasia of the left anterior descending artery (arrows). Intracoronary infusion of nitroglycerin did not change the diameter, excluding the presence of vasospasm. A: before infusion of nitroglycerin. B: after infusion of nitroglycerin.

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  Fig. 5 99mTc-tetrofosmin-gated myocardial perfusion scintigraphy showing a fixed apical and anterior defect. Three perfusion polar maps (from left to right: stress, rest, and reversibility) show extent and severity of perfusion defect.

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  Fig. 6 Cardiac CT angiography demonstrating hypoplasia of the left anterior descending artery in its mid-to-distal portion (arrows). A: three-dimensional volume rendering image, left anterior view. B: curved multiplanar reformatted image, left posterior view.

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  Fig. 7 Contrast-enhanced cardiac CT scans showing thinning of the apical wall of the left ventricle with calcifications (arrows), suggestive of long-standing myocardial infarction. A: four-chamber view. B: two-chamber view. C: short-axis view.

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  Fig. 8 Contrast-enhanced magnetic resonance images showing diffuse thinning and aneurysmal dilatation of the apical wall of the left ventricle with delayed enhancement (arrows), suggesting old myocardial infarction. A: four-chamber view. B: two-chamber view. C: short-axis view

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