Acute anterior myocardial infarction in a young male patient homozygous for the factor V Leiden mutation

Abstract

There are several reports on the association between the factor V Leiden mutation and acute myocardial infarction (AMI) in young patients, in particular young males. A 28-year-old male patient was admitted with severe chest pain of new onset. He was an active smoker. His father had a history of coronary artery disease and AMI after the age of 45 years. There were no other major coronary risk factors. His electrocardiogram showed ST-segment elevation in the precordial leads V1 to V5. His blood pressure, pulse rate, and other clinical parameters were stable. Emergency coronary angiography showed a significant narrowing in the mid-portion of the left anterior descending (LAD) artery with a moderate intracoronary thrombus, and no or minimal atherosclerosis. The other coronary arteries were normal. Direct stenting was performed for the culprit lesion, which resulted in relief of obstruction and significant improvement in the LAD artery. DNA samples isolated from the peripheral blood were analyzed by polymerase chain reaction and the patient was found to be homozygous for the factor V Leiden mutation. Transthoracic echocardiography before discharge showed only mild hypokinesis of the anterior and apical segments.