Multiple distal coronary artery thrombosis in acute myocardial infarction: a rare presentation

Description 

A 47-year-old man was referred to us with severe retrosternal chest pain and diaphoresis 6 hours back. Except for smoking, he had no other risk factors for coronary artery disease. The patient was haemodynamically stable and physical examination was unremarkable. The ECG done at the referral hospital revealed changes suggestive of inferolateral wall ST elevation myocardial infarction (STEMI) (figure 1), and left circumflex coronary artery was the most likely culprit vessel. Echocardiogram revealed hypokinesia of the inferolateral wall with mild mitral regurgitation. The patient was immediately shifted to the catheterisation lab and coronary angiogram was done. However, to our surprise, both the terminal branches of the major obtuse marginal artery and the distal segment of the left anterior descending coronary artery were occluded by thrombi in their distal segments (figure 2, videos 1 and 2). Because of the distal location of the thrombi, we...

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