Acute myocardial infarction type 2 secondary to the obstructive sleep apnea

We report a case of a 54-year-old obese, loudly snoring male, who presented to the hospital with typical ischemic chest pain of early morning onset, and high blood pressure values. A standard 12-lead ECG performed on admission showed ST-segment elevation in leads II, III, aVF, V1 and ST-segment depression in leads I, aVL, V2 to V4, but coronary angiography revealed no evidence of plaque rupture or erosion in an epicardial coronary vessel. Performed polysomnography confirmed severe obstructive sleep apnea (OSA). According to the universal definition of myocardial infarction patient was diagnosed with acute ST-segment elevation myocardial infarction type 2, caused probably by sudden blood pressure rise secondary to apnea episode in the course of OSA. Patient was treated with continuous positive airway pressure device and suffered no further adverse cardiovascular event during 12 months of follow-up. The case highlights importance of further investigation of novel risk factors such as OSA, and possibly listing it as one of the causes of acute myocardial infarction type 2. (C) 2013 The Czech Society of Cardiology. Published by Elsevier Urban & Partner Sp.zo.o. All rights reserved.