PMID- 23498821
OWN - NLM
STAT- MEDLINE
DCOM- 20130830
LR  - 20151119
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 45
IP  - 2
DP  - 2013 Mar
TI  - ST-elevation myocardial infarction following heart transplantation as an unusual 
      presentation of coronary allograft vasculopathy: a case report.
PG  - 787-91
LID - S0041-1345(12)01328-0 [pii]
LID - 10.1016/j.transproceed.2012.08.021 [doi]
AB  - BACKGROUND: The presentation, mechanisms, and incidence of ST elevation 
      myocardial infarction (STEMI) in heart transplant recipients have been 
      characterized only to a limited degree in the current literature. Herein, we 
      present a unique case of STEMI years after heart transplantation with a focus on 
      the salient features of its diagnosis and interventions. We also provide a review 
      of the epidemiology of this phenomenon. CASE REPORT: A 33-year-old woman who was 
      status post cardiac transplantation for dilated cardiomyopathy presented to the 
      clinic with mild nonspecific fatigue and concern after having noticed relative 
      bradycardia compared with her posttransplantation baseline heart rate. 
      Electrocardiogram (ECG) showed junctional rhythm and inferior ST elevations, 
      likely reflecting nodal ischemia. Troponins were grossly positive and 
      echocardiogram showed marked right ventricular dysfunction. RESULTS: Successful 
      percutaneous coronary intervention (PCI) with aspiration thrombectomy and 
      drug-eluting stent placement was emergently performed. The heart's rhythm soon 
      returned to sinus tachycardia. Right ventricular wall-motion abnormalities 
      resolved. The patient suffered no clinical sequelae of her STEMI. CONCLUSION: 
      This case illustrated that "classic" symptoms of STEMI may not occur at all in 
      the setting of heart transplantation. To our knowledge, this is the first case of 
      posttransplantation STEMI presenting as asymptomatic bradycardia, and highlights 
      the importance of maintaining high clinical suspicion for ischemia in transplant 
      recipients with subtle changes. In reviewing the epidemiology of this case, we 
      locate and bundle different types of studies that have directly or indirectly 
      looked at STEMI in heart transplantation. For a variety of putative 
      pathophysiological reasons, STEMI is indeed a rare manifestation of the common 
      transplant phenomenon of coronary artery vasculopathy (CAV).
CI  - Copyright (c) 2013 Elsevier Inc. All rights reserved.
FAU - Peter, S
AU  - Peter S
AD  - Stanford University Hospital, Stanford, Calif 94305-5110, USA.
FAU - Hulme, O
AU  - Hulme O
FAU - Deuse, T
AU  - Deuse T
FAU - Vrtovec, B
AU  - Vrtovec B
FAU - Fearon, W F
AU  - Fearon WF
FAU - Hunt, S
AU  - Hunt S
FAU - Haddad, F
AU  - Haddad F
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
RN  - 0 (Biomarkers)
RN  - 0 (Troponin)
SB  - IM
MH  - Adult
MH  - Biomarkers/blood
MH  - Bradycardia/etiology/physiopathology
MH  - Coronary Angiography
MH  - Coronary Artery Disease/diagnosis/*etiology/physiopathology/therapy
MH  - Echocardiography, Doppler, Color
MH  - Electrocardiography
MH  - Female
MH  - Heart Rate
MH  - Heart Transplantation/*adverse effects
MH  - Humans
MH  - Myocardial Infarction/diagnosis/*etiology/physiopathology/therapy
MH  - Percutaneous Coronary Intervention/instrumentation
MH  - Stents
MH  - Thrombectomy
MH  - Time Factors
MH  - Treatment Outcome
MH  - Troponin/blood
MH  - Ventricular Dysfunction, Right/etiology/physiopathology
MH  - Ventricular Function, Right
EDAT- 2013/03/19 06:00
MHDA- 2013/08/31 06:00
CRDT- 2013/03/19 06:00
PHST- 2012/06/27 00:00 [received]
PHST- 2012/08/28 00:00 [accepted]
PHST- 2013/03/19 06:00 [entrez]
PHST- 2013/03/19 06:00 [pubmed]
PHST- 2013/08/31 06:00 [medline]
AID - S0041-1345(12)01328-0 [pii]
AID - 10.1016/j.transproceed.2012.08.021 [doi]
PST - ppublish
SO  - Transplant Proc. 2013 Mar;45(2):787-91. doi: 10.1016/j.transproceed.2012.08.021.