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Inferior vena cava (IVC) agenesis is a rare congenital anomaly that has been implicated in up to 5% of unprovoked deep vein thrombosis (DVT) cases in young men under 30 years old. A venous Doppler ultrasound revealed an extensive right lower extremity DVT.
MINOCA may be due to: coronary spasm, coronary microvascular dysfunction, plaque disruption, spontaneous coronary thrombosis/emboli , and coronary dissection; myocardial disorders, including myocarditis, takotsubo cardiomyopathy, and other cardiomyopathies. This is in spite of the known proclivity of tighter stenoses to thrombose.
Genetic protein S (PS) deficiency caused by PROS1 gene mutation is an important riskfactor for hereditary thrombophilia.Case introductionIn this case, we report a 28-year-old male patient who developed a severe pulmonary embolism during his visit. Ultrasound showed no thrombosis in the veins of both lower limbs.
The commonest causes of MINOCA include: atherosclerotic causes such as plaque rupture or erosion with spontaneous thrombolysis, and non-atherosclerotic causes such as coronary vasospasm (sometimes called variant angina or Prinzmetal's angina), coronary embolism or thrombosis, possibly microvascular dysfunction.
The ways to tell for certain include intravascular ultrasound (to look for extra-luminal plaque with rupture) or "optical coherence tomography," something I am entirely unfamiliar with. The authors recommend using optical coherence tomography or intravascular ultrasound imaging in patients with evidence of nonobstructive CAD by angiogram.
Smith Major Learning Point: The worst riskfactor for a bad outcome in OMI is young age because cardiologists cannot believe that a young person can have an OMI. Beware a negative Bedside ultrasound. He was readmitted a few weeks later for a heart failure exacerbation, diuresed, and discharged again. This gets drilled into them.
Deep Vein Thrombosis (DVT) : A blood clot occurring in a deep vein. Causes include infection, malignancy, surgery, scar tissue formation, trauma, deep vein thrombosis (DVT), radiation or other cancer treatment. Carotid Ultrasound : Evaluates blood flow to the brain and detects stroke riskfactors.
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