Christian O. Chávez, Department of Cardiology, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo, Paraguay
Osmar A. Centurión, Department of Cardiology, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo; Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora. Paraguay
Karina E. Scavenius, Department of Cardiology, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo; Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora. Paraguay
Laura B. García, Department of Cardiology, Hospital de Clínicas, Asunción National University (UNA), San Lorenzo; Department of Health Sciences Investigation, Sanatorio Metropolitano, Fernando de la Mora. Paraguay


Several studies suggest that gene mutations from thrombophilia may constitute a significant risk factor for coronary artery disease, especially in young patients with normal coronaries and non-significant lesions. It is presented a case of a 42-yearold male patient who arrived at the emergency room due to an acute myocardial infarction. The electrocardiogram showed an ST elevation with upward convexity of 4 mm from V1 to V4 and of 1 mm at V5 and V6. Cardiac enzymes were positive (troponin I 8.4 ng/dl, normal range < 1 ng/dl). It was found septum and apical hypokinesia, with an ejection fraction of 44%. The culprit lesion of the infarction was treated with primary angioplasty, successfully dilating the left anterior descending coronary artery. However, spontaneous thrombi appeared at the middle third of the circumflex artery, an area without occlusive lesions previously. A full laboratory assessment for prothrombotic state diseases revealed positivity for gene mutations at A1298C from the methylene tetrahydropholate reductase (MTHFR) and plasminogen activator inhibitor-1 (PAI-1). Gene mutations at A1298C from the MTHFR and PAI-1 should be considered in young patients with acute coronary syndrome, mainly when thrombi are found in non-culprit arteries with no or non-significant coronary lesions.



Keywords: Myocardial infarction. Genetic testing. Coronary vessels.