Left ventricular myocardial infarction in a young patient with a myocardial bridge of the coronary artery

The article describes a clinical case of circular apical myocardial infarction of the left ventricle in a young patient without risk factors for coronary artery disease with an identified myocardial bridge of the coronary artery, vaccination with vector vaccine and HIV-positive status without antiretroviral therapy. The clinical picture was characterized by pain syndrome in the form of pressing pains behind the sternum with irradiation to both arms, increased cardiospecific enzymes, typical ECG changes in the form of ST segment elevation and zones of hypokinesis during echocardiography. Coronary angiography revealed a myocardial bridge in the anterior descending artery in the middle segment, narrowing the vessel lumen by 60%, and thrombotic occlusion in the distal segment. A hemodynamically significant myocardial bridge was located in the infarct-dependent artery, which suggested its role in the genesis of myocardial infarction. A blood clot in the cavity of the left ventricle and occlusion of the coronary artery made it possible to talk about hypercoagulation. Possible causes of thrombosis may be vaccination with a vector vaccine, positive HIV status without antiretroviral therapy, and a previous coronavirus infection. The systemic nature of hypercoagulation is indicated by the transient cerebrovascular accident that developed in the patient against the background of myocardial infarction.

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