The role of coronary artery abnormalities in the development of myocardial infarction in young patients (description of clinical cases)

Relevance. Congenital anomalies of the coronary arteries (CAs) are a rare pathology. Its significance in the development of myocardial infarction (MI) is ambiguous and requires further study. Aim. To study the materials of medical records of young patients with MI on the background of CA abnormalities. To assess the role of coronary abnormality and additional risk factors that led to the development of acute coronary pathology at a young age. Materials and methods. Analysis of medical records of inpatient patients with the study of anamnesis, objective indicators, results of laboratory and instrumental research methods, comparison of the results obtained with literary data. Results. Two clinical cases of young patients with MI are presented. The first 32-year-old patient had an abnormal discharge of the right CA during coronary angiography. The second 42-year-old patient was found to have a rare malformation of the CA – coronary pulmonary fistulas, which can lead to "coronary theft syndrome", exacerbate myocardial ischemia and contribute to the development of MI. In patients, MI developed without previous angina pectoris, at a young age, both patients had risk factors for atherosclerosis: smoking, obesity, dyslipidemia, arterial hypertension. Multivessel pronounced stenosing atherosclerosis of the CAs and atherothrombosis were determined on coronary angiography. Both patients underwent CA stenting. Conclusion. Congenital anomalies of the CAs are very rare and are an anatomical finding during coronary angiography. The examined patients with this anomaly developed MI at a young age. The main role belonged to risk factors leading to stenosing atherosclerosis of the CAs by more than 50% and atherothrombosis. Congenital anomalies of the CAs in the presented patients, especially coronary pulmonary fistulas, can further worsen the blood supply to the myocardium and create prerequisites for early damage and necrosis. The role of congenital anomalies of the CAs in the development of MI depends on the severity of the defect and its effect on coronary hemodynamics.