BMJ Case Reports 2011; doi:10.1136/bcr.02.2011.3799
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Underlying cause discovered for a prior idiopathic AMI

  1. Whyte G6
  1. 1Centre for Sports Medicine and Human Performance, Brunel University, London, UK
  2. 2Blackrock Clinic, St Vincent’s University Hospital, Dublin, Ireland
  3. 3Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  4. 4Centre for Exercise and Nutrition Science, University of Chester, Chester, UK
  5. 5Department of Cardiology, Kings College Hospital, London, UK
  6. 6Research Institute for Sport and exercise Science, Liverpool John Moores University, Liverpool, UK
  1. Correspondence to Godfrey R, richard.godfrey{at}


The authors previously reported on an active, young male with normal coronaries who sustained an acute myocardial infarction (AMI). The acute cause was a coronary thrombus; however, the cause of this thrombus and a definitive diagnosis remained elusive for 18 months until a new series of events, including symptoms of breathlessness, dizziness and collapse led to acute hospital admission. CT scan revealed numerous deep venous thromboses in the right leg and bilateral pulmonary emboli (PE). Acute pharmacological thrombolysis eliminated breathlessness and significantly reduced the risk of mortality. Clinical consensus suggests a coagulopathy, requiring indefinite treatment with Warfarin. In young individuals presenting with AMI, lifestyle, personal, family and clinical history should be considered and coronary artery disease should not be assumed until further tests have eliminated coagulopathy. In those presenting with breathlessness and a history which includes AMI, a CT scan is indicated to eliminate concerns of venous thromboembolism generally and PE specifically where untreated survival times are short.


  • Competing interests None.

  • Patient consent Obtained.

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