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Vol. 38. Num. 2.
Pages 73-170 (February 2019)
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Vol. 38. Num. 2.
Pages 73-170 (February 2019)
Image in Cardiology
DOI: 10.1016/j.repce.2017.08.012
Open Access
Acute myocardial infarction complicated with cardiogenic shock as a late onset of Kawasaki disease
Enfarte agudo do miocárdio complicado por choque cardiogénico devido a início tardio da doença de Kawasaki
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Rocío González Ferreiroa,b,
Corresponding author
ferreiro_44@hotmail.com

Corresponding author.
, Diego López Oteroa, Alfredo Redondo Diégueza, José Luis Martínez Sandea, Ramiro Trillo Nouchea, José Ramón González Juanateya
a Servicio de Cardiología y Unidad Coronaria, Complexo Hospitalario Universitario de Santiago de Compostela; CIBERCV, A Coruña, Spain
b Servicio de Cardiología, Hospital Universitario de Salamanca; Instituto de Investigación Biomédica de Salamanca (IBSAL); Facultad de Medicina, Universidad de Salamanca; CIBERCV, Salamanca, Spain
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A 61-year-old man was admitted to our hospital due to acute inferior myocardial infarction, complicated by complete heart block and cardiogenic shock. The patient had received dual antiplatelet therapy (aspirin and ticagrelor) and an emergency coronary angiogram was performed. It should be noted that he had previously been with hypertension, hypercholesterolemia, a 48×41-mm abdominal aortic aneurysm and gastric ulcer.

Single-plane fluoroscopy (Figure 1A) and coronary angiography showed a giant calcified aneurysm (73 mm×72 mm) of the mid-right coronary artery (RCA), and smaller aneurysms that were proximal and distal to the first. The proximal RCA was occluded by a thrombus (Figure 1B) so percutaneous revascularization could not be performed. The left coronary artery had multiple calcified aneurysms, and severe stenosis of the proximal anterior descending coronary artery (Figures 2A–C) was found. We performed ascending aortography, which was normal. These findings could be related to Kawasaki disease (KD). Despite good evolution following cardiogenic shock, the patient had upper gastrointestinal bleeding, a major and acute complication, which was fatal.

Figure 1.

Right coronary angiogram.

(A) Calcified giant aneurysm of the right coronary artery is easier to see on the fluoroscopy; (B) total thrombotic occlusion of the proximal right coronary artery.

(0.19MB).
Figure 2.

Left coronary angiogram.

Fluoroscopy (A) and left coronary angiography (B) and (C) show arterial ectasia and calcification with serial aneurysms and significant stenosis in the proximal anterior descending coronary artery.

(0.37MB).

KD is a self-limiting acute systemic vasculitis of unknown etiology, which affects infants and children. It usually involves small and medium-sized arteries, and commonly the coronary arteries. The morbidity and mortality in KD are associated with the development of coronary aneurysms that can lead to myocardial infarction. In adults, most cases are reported in patients under the age of 40 years. This case is of great interest due to the late onset and the severe form of the disease.

Conflicts of interest

The authors have no conflicts of interest to declare.

Copyright © 2018. Sociedade Portuguesa de Cardiologia
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Revista Portuguesa de Cardiologia (English edition)

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