Introduction. The most common cause of myocardial infarction is ischaemia caused by the coronary atherosclerosis, but there are other conditions that may precipitate myocardial infarction, such as anaemia.
Case report. We present the case of a 83 year-old man who was admitted to the Clinical Emergency Hospital of Bucharest for asthenia, cough and hemoptysis, recurrent episodes of typical angina, dyspnea at rest. The onset of symptoms was gradual, a few months prior to seeking medical advice. The initial diagnosis was: congestive heart failure class III NYHA, permanent atrial fibrillation, mitral insufficiency, tricuspid insufficiency, ischaemic heart disease, pulmonary hypertension, bronchiectasis, anaemic syndrome. Despite the treatment for his illnesses, his condition worsened
and in the second day of hospitalization, the patient had a prolonged episode of anginal pain, for 25 minutes, while ischaemic changes appeared on ECG and myocardial necrosis enzymes increased. By reassessing his condition, we arrived to the final diagnosis which can explain the clinical picture: type 2 myocardial infarction without ST – segment elevation due to an anaemic syndrome, which led to the imbalance between demand and supply of oxygen.
Conclusion. Anaemia may cause acute coronary syndrome, especially in patients with cardiovascular risk factors. In these patients, the management of the acute coronary syndrome is more difficult.
Keywords: acute coronary syndrome, myocardial infarction without ST-segment elevation, anaemia.
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Horodinschi Ruxandra-Nicoleta, MD
Clinical Emergency Hospital of Bucharest, Internal Medicine Clinic
8 Calea Floreasca, Bucharest, Romania