Acute Myocardial Infarctionin a Patient with Nephrotic Syndrome and Polycythemia: A Case Report

Abstract

          The modifiable risk factors for acute myocardial infarction (AMI) include hyperlipidemia, diabetes mellitus, smoking, high blood pressure, visceral obesity, lack of exercise, high risk food intake and psychological stress. In this report, we presented the young man with AMI who had the underlying nephrotic syndrome and polycythemia. He was a 25-year-old Thai patientpresenting with acute chest pain 3 hours before admission. The electrocardiogram showed the ST elevations at leads II, III, AVF and the T inversions at leads V1-V4 with sinus tachycardia. The CK-BM and troponin-I enzymes were > 600 ng/ml and > 80 ng/ml, respectively. His hemoglobin concentration was 18.3 g% while other blood tests were: albumin 2.6 g%, cholesterol 365 mg%, triglyceride 567 mg%, FBS 102 mg%, protein S24 %, beta₂ glycoprotein IgM 72.31 U/ml, noJAK2 V617F mutation, serum erythropoietin 2.4 mIU/ml. The urine protein was 14,673 mg/day. The diagnosis of AMI in the young with unusual risk factors including nephrotic syndrome, polycythemia, protein S deficiency, the presence of anti beta₂ glycoprotein IgM, and hyperlipidemia. He was immediately treated with thrombolytic therapy and the coronary angiography. The thrombotic occlusion was demonstrated at the mid portion of the left circumflex coronary artery and he was also treated with medicated stent, ASA, phlebotomy and plasma transfusion. He dramatically responded to therapy and the elevated ST segment became normal after the coronary intervention. The possible relationship between AMI and nephrotic syndrome and polycythemia was discussed.