Prompt Recognition and Percutaneous Coronary Intervention Leads to Favorable Myocardial Recovery After ST-Segment Elevation Myocardial Infarction Secondary to Acute Promyelocytic Leukemia: Pediatric Case Report

Acute myocardial infarction (AMI) is extremely rare in children, and unlike the adult disease, the etiology of the infarction is rarely due to atherosclerotic coronary disease. This unique reported case involved a 15-year-old boy with severe chest pain who presented with an ST-segment-elevation myoc...

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Bibliographic Details
Published in:Pediatric cardiology 2013-12, Vol.34 (8), p.2047-2051
Main Authors: Thomas, Tamara O., Ramachandran, Preeti, Jefferies, John L., Beekman, Robert H., Hor, Kan, Lorts, Angela
Format: Article
Language:English
Subjects:
Adolescent
Blood clot
Cancer
Cardiac Surgery
Cardiology
Case Report
Chemotherapy
Coronary Angiography - methods
Coronary Circulation - physiology
Development and progression
Electrocardiogram
Electrocardiography
Enzymes
Heart attack
Humans
Leukemia, Promyelocytic, Acute - complications
Leukemia, Promyelocytic, Acute - diagnosis
Male
Medicine
Medicine & Public Health
Myocardial Infarction - diagnosis
Myocardial Infarction - etiology
Myocardial Infarction - surgery
Pediatrics
Percutaneous Coronary Intervention
Recovery of Function
Thrombosis
Time Factors
Transluminal angioplasty
Vascular Surgery
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Summary:Acute myocardial infarction (AMI) is extremely rare in children, and unlike the adult disease, the etiology of the infarction is rarely due to atherosclerotic coronary disease. This unique reported case involved a 15-year-old boy with severe chest pain who presented with an ST-segment-elevation myocardial infarction secondary to in situ thrombus formation in the left anterior descending (LAD) coronary artery. The initial electrocardiogram (ECG) had a Q-wave pattern in V6 and ST depression in the inferior leads with ST-segment elevation in reciprocal leads. The cardiac enzymes and routine labs showed evidence of myocardial damage. The boy was urgently taken to the cardiac catheterization laboratory for percutaneous coronary intervention, where complete occlusion of the LAD was found and successfully stented. Eventually, a peripheral blood smear showed pancytopenia with 38 % hypergranular blast-like cells consistent with acute myeloid leukemia (AML), and chemotherapy with all-transretinoic acid was implemented. This first pediatric case report of an AML-associated AMI emphasizes the benefit resulting from expedient reperfusion of the ischemic myocardium by quick reestablishment of coronary perfusion. It also emphasizes the limitations of existing noninvasive technologies in detecting myocardial viability.
ISSN:0172-0643
1432-1971
DOI:10.1007/s00246-012-0604-1