Aggressive acute coronary thrombosis in ulcerative colitis flare.
Gorgis S, Dhillon D, Mishra K, Saleh A, Basir M, and Fuller B. Aggressive acute coronary thrombosis in ulcerative colitis flare. Journal of the American College of Cardiology 2020; 75(11):3302.
J Am Coll Cardiol
Background Thromboembolic disease is a well-recognized complication of Ulcerative Colitis (UC), but coronary involvement is rare. Chest pain in UC flare should raise suspicion for acute coronary thrombosis. Case A 46 year old male with UC was admitted after 3 weeks of bloody diarrhea despite treatment with prednisone. He also reported severe refractory chest pain. ECG showed ST-segment elevation myocardial infarction in inferior/lateral leads. Emergent left heart catheterization (LHC) revealed a large thrombus in mid left anterior descending (LAD) artery with distal embolization. Aspiration thrombectomy was unsuccessful. A drug eluting stent (DES) was placed in mid-LAD. Intracoronary vasodilators improved distal coronary flow. The patient was continued on DAPT. Five days later, his chest pain recurred. Decision-making LHC showed acute in-stent thrombosis. Two DES were placed in overlapping fashion to proximal-mid LAD with PTCA on the diagonal. Persistent thrombus was treated with balloon inflations. The patient continued to be symptomatic, so an intra-aortic balloon bump (IABP) was placed. He was continued on DAPT. Hemodynamics and chest pain improved in next 2 days, and IABP was removed. Conclusion Acute coronary thrombosis in pro-inflammatory states are challenging to treat, since both the underlying condition and treatment of UC are pro-thrombotic. Close monitoring and consideration of mechanical support devices may improve coronary perfusion while controlling the underlying flare.