Myocardial Infarction in Young Women with Normal Coronary Arteriograms

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Abstract
Two women, ages 34 and 36 years, suffered an acute transmural anterior myocardial infarction accompanied by typical ECG and serum enzyme changes. At the time of selective cinecoronary arteriography 29 and 57 months later, however, neither had demonstrable narrowing of any coronary artery. Both have persistent ECG changes of an anterior infarct and markedly diminished contractions of a large segment of the anterior wall and apex on left ventriculogram. Neither before nor after infarction has either patient experienced angina pectoris. Both patients are premenopausal, and neither of them has diabetes, hypertension, obesity, valvular heart disease, a lipoprotein abnormality, or a family history of premature coronary arterial disease. Both smoke cigarettes. At the time of infarction one patient was taking an oral contraceptive and the other was 11-days postpartum. The pathogenesis of the myocardial infarcts in these patients is unknown. Embolization or in situ thrombosis of a previously normal anterior descending coronary artery with subsequent clot lysis would explain the infarcts, the normal coronary arteriograms, and the absence of prior or subsequent angina.