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Catastrophic antiphospholipid syndrome causing ST-segment elevation myocardial infarction with non-obstructive coronary arteries
  1. James Cranley1,
  2. Unni Krishnan1,2,
  3. Katharine Tweed1 and
  4. Rudolf Martin Duehmke3
  1. 1 Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
  2. 2 Cardiology, Addenbrooke’s Hospital NHS Foundation Trust, Cambridge, UK
  3. 3 Cardiology, West Suffolk NHS Foundation Trust, Bury Saint Edmunds, UK
  1. Correspondence to Dr Rudolf Martin Duehmke, duhmke{at}


A 51-year-old woman with known primary antiphospholipid syndrome presented with a 4-day history of chest and abdominal pain, inferior ST-segment elevation on a 12-lead ECG and a subtherapeutic international normalised ratio. In view of a significantly raised high-sensitivity troponin I assay, inferior wall hypokinesis on transthoracic echocardiography and despite unobstructed epicardial vessels on emergency coronary angiography, a diagnosis of myocardial infarction was made. Furthermore, the patient also developed both bilateral adrenal haemorrhages leading to acute adrenal insufficiency and microvascular thrombotic renal disease concurrently. The patient therefore fulfilled the diagnostic criteria for catastrophic antiphospholipid syndrome presenting with cardiac, endocrine and renal involvement. Early diagnosis permitted appropriate treatment with anticoagulation, dual antiplatelet therapy, secondary prevention and corticosteroid replacement therapy and led to a full recovery. This case highlights first the importance of adequate anticoagulation in antiphospholipid syndrome and, second, the potentially fatal, multiorgan complication of failure to do so.

  • ischaemic heart disease
  • venous thromboembolism
  • adrenal disorders
  • haematology (incl blood transfusion)
  • renal medicine

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  • Contributors JC, UK, KT and RMD were involved in the clinical care of the patient. JC and RMD diagnosed the patient’s condition. KT provided the clinical images and figure legends. JC, UK and RMD contributed to the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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