Antiphospholipid Syndrome Manifesting As Myocardial Infarction: A Case Report and Review of the Literature Publisher



Shahi S ; Nematollahi S ; Mohammadi A ; Aghajani H
Source: Indonesian Journal of Cardiology Published:2025

Abstract

Background: Antiphospholipid Syndrome (APS) is characterized by the presence of antiphospholipid antibodies, including lupus anticoagulant, anticardiolipin antibodies, and β2-glycoprotein I. These antibodies target phospholipids and associated proteins, leading to diverse clinical manifestations such as stroke, myocardial infarction, and deep vein thrombosis. Acute myocardial infarction caused by arterial thromboembolism is a rare first manifestation of APS. Case Illustration: We present a case study of a 37-year-old female with a history of Deep Vein Thrombosis (DVT) and no identifiable risk factors, who, a decade ago and recently, experienced a sudden Myocardial Infarction (MI) due to arterial thrombosis. The angiographic appearance and the need for angioplasty were challenging at presentation, as the clot was migratory and had moved between coronary vessels. We conducted a thrombophilia evaluation due to the unusual site of thrombosis and the patient’s age at presentation, which led us to establish the diagnosis of APS. Conclusions: This case highlights the rare but essential association between APS and recurrent MI, as well as the unique angiographic behavior of APS-related coronary thrombi that can complicate percutaneous coronary intervention. While long-term vitamin K antagonist therapy remains standard for secondary prevention, clinicians should recognize APS as a potential cause of MI in young patients and anticipate procedural and therapeutic challenges beyond anticoagulation alone. © 2025 Indonesian Heart Association. All rights reserved.