Acute coronary thrombosis in a patient with septic shock without any evidence of disseminated intravascular coagulation

• Published in: BMJ case reports Vol. 2009; no. aug20 1; p. bcr0520091887
• Main Authors: Ahmed, Imdad, Nelson, William B, Biring, Timinder S, House, Chad M, Marini, John, Dahiya, Ranjan
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 2009; BMJ Publishing Group
• Series: Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
• Subjects: Abdomen; Blood clots; Blood platelets; Cardiovascular disease; Coronary vessels; Electrocardiography; Family medical history; Findings That Shed New Light on the Possible Pathogenesis of a Disease or an Adverse Effect; Heart attacks; Laboratories; Male; Proteins; Sepsis; Thrombosis; USA/Canada; White
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr.05.2009.1887

The case report describes an interesting and unusual finding of acute coronary artery thrombosis in a patient presenting with septic shock without any clinical and laboratory evidence of disseminated intravascular coagulation (DIC). The patient presented with leucocytosis and refractory hypotension requiring pressor support and found to have anterior and inferior ST-elevation in 12-lead electrocardiogram. Coronary angiogram revealed acute thrombotic occlusions in the proximal right coronary artery and the proximal left anterior descending coronary artery. There was no occlusive atherosclerotic coronary artery disease. The patient underwent mechanical thrombectomy. Haemodynamic parameters obtained from right heart catheterisation confirmed sepsis as the aetiology of hypotension. The patient was treated successfully with broad spectrum antibiotics, pressors and intravenous fluid. Acute myocardial infarctions as a complication secondary to disseminated intravascular coagulation in patients with sepsis and septic shock have been described in the literature. To our knowledge, this is the first reported case of acute coronary artery thrombosis in patient with septic shock without DIC and without any underlying occlusive coronary artery disease.