Myocardial infarction under oral contraceptives: Simultaneous thrombotic occlusion of the left anterior descending and circumflex coronary arteries

A 38-year-old, previously healthy mother of one child, with cigarette smoking and oral contraceptive medication as only risk factors suffered an acute anterior myocardial infarction without prior anginal complaints. Angiographically there were thrombotic occlusions of the LAD after the first septal branch and also of the distal left circumflex coronary artery. Six days after catheter recanalisation of the LAD and i.c. infusion of urokinase, there were small residual thrombi in the otherwise perfectly normal LAD and in a diagonal branch whereas the circumflex coronary artery was completely normal. The left ventricle showed anteroseptal (but not inferior) akinesis. The case report supports the hypothesis that myocardial infarctions under oral contraceptive medication are a separate disease entity unrelated to coronary atherosclerosis and may be the consequence of a ''coagulation accident''.