Preview

Russian Journal of Cardiology

Advanced search

ST-segment elevation acute coronary syndrome in a child with Duchenne muscular dystrophy: a case report

https://doi.org/10.15829/1560-4071-2024-5763

EDN: JVXBZN

Abstract

Introduction. Duchenne muscular dystrophy is an X-linked muscle disorder caused by the dystrophin absence. This leads to the death of muscle cells and cardiomyocytes and their subsequent replacement with adipose and fibrous tissue. Clinically, this disease manifests itself as progressive muscle weakness and cardiomyopathy. We report a case of a young patient with acute myocardial injury without coronary artery occlusion due to Duchenne muscular dystrophy.

Brief description. A 15-year-old male patient with Duchenne muscular dystrophy, no risk factors for coronary artery disease and known cardiac diseases presented with pressing chest pain. Electrocardiography showed ST segment elevation on the inferior and lateral walls. Given the pressing chest pain, electrocardiographic abnormalities and elevated cardiac biomarkers, an initial working diagnosis of acute myocardial infarction was made and the patient was taken to the catheterization laboratory for coronary angiography, which demonstrated normal cardiac anatomy and coronary arteries without hemodynamically significant stenoses. The patient was discharged from the hospital on day 14 with a final diagnosis of Duchenne muscular dystrophy cardiomyopathy and recommendations for perindopril 5 mg daily and bisoprolol 5 mg daily.

Discussion. Frontline practitioners should be aware of the high prevalence of car diomyopathy in patients with Duchenne muscular dystrophy, which increases with age. Cardiac biomarkers may be chronically elevated in this disease. However, a high suspicion combined with echocardiography and magnetic resonance imaging may help in diagnosing acute myocardial injury in these cases. Based on this case, we discuss the dilemmas of management and follow-up of this complex group of patients.

About the Authors

Z. G. Tatarintseva
Research Institute — Ochapovsky Regional Clinical Hospital № 1; Kuban State Medical University
Russian Federation

Candidate of Medical Sciences, Head of the Cardiology Department of the State Medical Institution "Scientific Research Institute-KKB No. 1 named after S. V. Ochapovsky", Assistant of the Department of Cardiac Surgery and Cardiology of the Faculty of Advanced Training and Professional Retraining of specialists of Kuban State Medical University

Krasnodar



O. V. Babicheva
Research Institute — Ochapovsky Regional Clinical Hospital № 1; Kuban State Medical University
Russian Federation

Ph.D., cardiologist of the State Budgetary Institution "Research Institute-KKB No. 1 named after. S. V. Ochapovsky,” Associate Professor of the Department of Cardiac Surgery and Cardiology of the Faculty of Training and Teaching Staff of KubSMU

Krasnodar



K. O. Barbuhatti
Research Institute — Ochapovsky Regional Clinical Hospital № 1; Kuban State Medical University
Russian Federation

Doctor of Medical Sciences, Head of Cardiac Surgery Department No. 2, Head of the Department

Krasnodar



References

1. Nowak KJ, Davies KE. Duchenne muscular dystrophy and dystrophin: pathogenesis and opportunities for treatment. EMBO Rep. 2004;5(9):872-6. doi:10.1038/sj.embor.7400221.

2. Verhaert D, Richards K, Rafael-Fortney JA, Raman SV. Cardiac involvement in patients with muscular dystrophies: magnetic resonance imaging phenotype and genotypic considerations. Circ Cardiovasc Imaging. 2011;4(1):67-76. doi:10.1161/CIRCIMAGING.110.960740.

3. Turner D, Ruemmele FM, Orlanski-Meyer E, et al. Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care-An Evidence-based Guideline From European Crohn's and Colitis Organization and European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018;67(2):257-91. doi:10.1097/MPG.0000000000002035. Erratum in: J Pediatr Gastroenterol Nutr. 2020;71(6):794. doi:10.1097/MPG.0000000000002967.

4. Mitropoulou P, Hobson A, Morton G, Anantharam B. ST-elevation myocardial infarction in a young patient with Duchenne's muscular dystrophy: a case report. Eur Heart J Case Rep. 2022;6(5):ytac184. doi:10.1093/ehjcr/ytac184.

5. Feingold B, Mahle WT, Auerbach S, et al. Management of cardiac involvement associated with neuromuscular diseases: a scientific statement from the American Heart Association. Circulation. 2017;136. doi:10.1161/CIR.0000000000000526.

6. Abutaleb ARA, McNally EM, Khan SS, еt al. Myocarditis in Duchenne Muscular Dystrophy After Changing Steroids. JAMA Cardiol. 2018;3(10):1006-10. doi:10.1001/jamacardio.2018.2695.

7. Fayssoil A, Abasse S, Silverston K. Cardiac Involvement Classification and Therapeutic Management in Patients with Duchenne Muscular Dystrophy. J Neuromuscul Dis. 2017;4(1):17-23. doi:10.3233/JND-160194.

8. Gorkova NB. Cardiomyopathy in progressive muscular dystrophy. Cardiology of the Volga Federal District: opportunities and prospects: III Congress of Cardiologists of the Volga Federal District, Samara: Medforum, 2010, рр. 141-2. (In Russ.) EDN UMYPSF.

9. McNally EM, Kaltman JR, Benson DW, et al.; Working Group of the National Heart, Lung, and Blood Institute; Parent Project Muscular Dystrophy. Contemporary cardiac issues in Duchenne muscular dystrophy. Working Group of the National Heart, Lung, and Blood Institute in collaboration with Parent Project Muscular Dystrophy. Circulation. 2015;5;131(18):1590-8. doi:10.1161/CIRCULATIONAHA.114.015151.

10. D'Amario D, Amodeo A, Adorisio R, et al. A current approach to heart failure in Duchenne muscular dystrophy. Heart. 2017;103(22):1770-9. doi:10.1136/heartjnl-2017-311269.

11. Giannitsis E, Mueller C, Katus HA. Skeletal myopathies as a non-cardiac cause of elevations of cardiac troponin concentrations. Diagnosis (Berl). 2019;6(3):189-201. doi:10.1515/dx-2019-0045.

12. Hor KN, Johnston P, Kinnett K, et al. Progression of Duchenne Cardiomyopathy Presenting with Chest Pain and Troponin Elevation. J Neuromuscul Dis. 2017;4(4):307-14. doi:10.3233/JND-170253.

13. Taqatqa A, Bokowski J, Al-Kubaisi M, et al. The Use of Speckle Tracking Echocardiography for Early Detection of Myocardial Dysfunction in Patients with Duchenne Muscular Dystrophy. Pediatr Cardiol. 2016;37(8):1422-8. doi:10.1007/s00246-016-1451-2.

14. Gulati R, Behfar A, Narula J, et al. Acute Myocardial Infarction in Young Individuals. Mayo Clin Proc. 2020;95(1):136-56. doi:10.1016/j.mayocp.2019.05.001.

15. Al Hajri HS, El Husseiny EM, Qayyum H. Chest Pain and Electrocardiographic Changes in a Child With Duchenne Muscular Dystrophy. Cureus. 2022;14(6):e26105. doi:10.7759/cureus.26105.

16. Duboc D, Meune C, Pierre B, et al. Perindopril preventive treatment on mortality in Duchenne muscular dystrophy: 10 years' follow-up. Am Heart J. 2007;154(3):596-602. doi:10.1016/j.ahj.2007.05.014.

17. Gainetdinova DD, Novoselova AA. Modern possibilities of diagnosis and treatment of Duchenne muscular dystrophy. Kazan Medical Journal. 2020;101(4):530-7. (In Russ.)doi:10.17816/KMJ2020-530.

18. Raman SV, Hor KN, Mazur W, et al. Eplerenone for early cardiomyopathy in Duchenne muscular dystrophy: a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2015;14(2):153-61. doi:10.1016/S1474-4422(14)70318-7.

19. Chernikova VV. Early diagnosis of cardiomyopathies in patients with Duchenne myodystrophy. Postgraduate readings — 2013: Materials of the reports of the All-Russian conference with international participation "Young Scientists in Medicine", Samara. 2013;(10):52-55. (In Russ.) EDN UHDBGH.


Supplementary files

  • Cardiovascular complications of Duchenne muscular dystrophy are well known and manifest as dilated cardiomyopathy.
  • Sometimes, following unusual presentations may be observed: ST-segment elevation myocardial infarction or acute myocardial injury with non-obstructive coronary arteries.
  • Follow-up of patients with Duchenne muscular dystrophy in specialized clinics is critical to ensure early detection of cardiovascular involvement and coordination of appropriate treatment.

Review

For citations:


Tatarintseva Z.G., Babicheva O.V., Barbuhatti K.O. ST-segment elevation acute coronary syndrome in a child with Duchenne muscular dystrophy: a case report. Russian Journal of Cardiology. 2024;29(10S):5763. (In Russ.) https://doi.org/10.15829/1560-4071-2024-5763. EDN: JVXBZN

Views: 253


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1560-4071 (Print)
ISSN 2618-7620 (Online)