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Acute myocardial infarction in a young patient with triple valve replacement
  1. Yash Paul Sharma,
  2. Krishna Prasad,
  3. Nitin Patel and
  4. Prashant Kumar Panda
  1. Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Dr Prashant Kumar Panda; prashantpanda85{at}


Rheumatic heart disease is an important cause of mortality and morbidity in developing countries, and is the leading cause of triple valve replacement. Myocardial infarction (MI) in such cases can be due to the coronary embolism from the prosthetic valves or due to atherosclerotic vascular disease. Intravascular imaging helps in delineating the cause. We present a case of a 34-year-old premenopausal woman with no conventional cardiovascular risk factors and had triple valve replacement 4 years ago and anterior wall MI with cardiogenic shock and left ventricular failure. She was managed with mechanical ventilation, thrombolysis, diuretics, double antiplatelets and anticoagulation with low molecular weight heparin. Intravascular ultrasound showed a lipid-rich plaque with associated plaque rupture and thrombosis. Intravascular imaging helps in delineating the cause of MI and further management. Atherosclerotic MI in a patient with no conventional risk factors is rare and needs to be considered.

  • cardiovascular medicine
  • heart failure
  • interventional cardiology
  • interventional cardiology
  • cardiovascular system

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  • Contributors NP, KP and PKP were involved in collection of data. KP was involved in writing the first draft. YPS and PKP were involved in conceptualisation and finalising the final draft.

  • 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.

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