Am Heart Hosp J. 2010;8(2):125–127


Lozenge Reference


Case Report


Intravascular Ultrasound and Angiographic Demonstration of Left Main Stem Thrombus— High-risk Presentation in a Young Adult with Anabolic Steroid Abuse


Pankaj Garg, MD, MRCP,1 Gershan Davis, MD, FRCP, FRACP, FACC, FESC,1 John Ian Wilson, BSc, MD, FRCP2 and Mohan Sivananthan, MBBS, MD, MRCP, FRCR, FACA2


We present a case of acute myocardial infarction in a young adult with a history of anabolic steroid abuse. On diagnostic coronary angiography and intravascular ultrasound, he was found to have a distal left main stem thrombus extending into the proximal left anterior descending artery and a large intermediate vessel. As he was hemodynamically stable and pain-free, he was managed conservatively with triple antiplatelet therapy (aspirin, clopidogrel, and abciximab). This was also to avoid the risk of ‘wiring the vessel,’ especially if there was underlying dissection. Repeat angiography a few weeks later showed complete thrombus resolution. This is the first reported case of extensive left main stem thrombus in a young patient with anabolic steroid abuse. Management of such cases is not straightforward and our case highlights one approach to both diagnosis and treatment.


A


nabolic androgenic steroids are used globally by athletes and young adults to gain muscle mass and strength.1


The pathophysiologic disease process is not well understood and relies mainly on multiple case reports and autopsy results of people who have had myocardial infarction secondary to steroid abuse. Potential mechanisms of cardiovascular toxicity of steroids include atherogenic, thrombotic, vasospastic, and direct myocardial injury, or a combination thereof.1


with numerous cardiac conditions. A few case reports have also reported myocardial infarction in this group of patients.1–5


The management of patients with myocardial infarction and anabolic steroid abuse is not well established. One case reported successful primary coronary intervention with an intracoronary stent in acute myocardial infarction.4


Another


case report failed to show any angiographic benefit of anticoagulation therapy in two patients with extensive intracoronary thrombosis.5


Their use and abuse is associated


In this article we report a patient who has experienced angiographic resolution of an intracoronary thrombus using triple antiplatelet therapy. We performed three diagnostic angiograms (one pre-treatment and two post-treatment) using intravascular ultrasound (IVUS) to assess progress with treatment. We also performed a rotational angiogram of the left coronary system to assess atheroma load in a single acquisition.


Case Report


A 24-year-old Asian man with no previous cardiac history presented to his local hospital with acute chest pain and borderline anterior ST elevation. There were no major cardiovascular risk factors and no relevant family history of coronary artery disease. There was no history of dyslipidemia. He was training regularly at the gym and had being using anabolic steroids. He was stabilized after admission with opiates and dual antiplatelet therapy before transfer to a regional center for cardiac catheterization. On diagnostic coronary angiography he was found to have a


• 1. Aintree Cardiac Centre, University Hospital Aintree, Liverpool; 2. Department of Cardiology, Leeds General Infirmary


• Correspondence: Pankaj Garg, MD, MRCP, Aintree Cardiac Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK. E: pankajvic@gmail.com


Winter 2010 Intravascular Ultrasound and Angiographic Demonstration of Left Main Stem Thrombus 125


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