Table 1 Timeline of the case presentation
Time | Events | |
|---|---|---|
Family History | • Parents: sudden death at the age of 63 years old caused by CAD and history of myocardial infarction at the age of 40 and 50 years old (father), heart failure and hypertension (mother) • Sudden death at the age of 56 caused by CAD and a history of cardiac arrest at the age of 46 (uncle) • Sudden death at the age of 60 with a history of hypertension and heart failure (aunt) | |
History of pregnancy complications | • 1st and 3rd pregnancy: preeclampsia with severe features, terminated at 34–35 weeks of pregnancy • 2nd pregnancy: spontaneous abortion at 6–8 weeks of pregnancy | |
Four years before presentation | • Transient Ischemic Attack (TIA) with symptoms of headache, gait and balance disorder • Clopidogrel 1 × 75 mg for 2 years | |
Six weeks before presentation | • 1st COVID-19 Vaccination (Sinovac) | |
One month before presentation | • Chest pain triggered during strenuous activity • 2nd COVID-19 Vaccination (Sinovac) | |
One week before presentation | • Chest pain triggered during light activity | |
Initial Presentation | Day 1 (pre-procedure) | • Onset of chest pain after running more than 3 km, slightly improved at rest • Initial assessment revealed NSTEMI • hs-TnT 118 ng/L • MSCT angiography showed significant coronary lesions • Diagnostic catheterization showed diffuse stenosis in proximal-mid LAD with subtotal occlusion in proximal, TIMI 2 flow, and diffuse stenosis in proximal-mid, subtotal occlusion in mid-RCA, TIMI 2 flow • PCI performed with implantation of 2 DES in LAD and 1 DES in RCA |
Follow-up | Day 1 (postprocedure) | • Patient was transferred to CVCU with hypotension, given fluid loading and norepinephrine drip down-titrated until stopped completely • After hemodynamic stabilization, the patient was transferred to the ward, and medications were initiated (bisoprolol 1 × 2.5 mg, ticagrelor 2 × 90 mg, aspirin 1 × 100 mg, rosuvastatin 1 × 40 mg, enoxaparin sodium IV 2 × 0.6 cc, lansoprazole 1 × 30 mg) |
4 days | • Enoxaparin sodium discontinued due to bleeding | |
5 days | • Patient was discharged | |
2 weeks 14 weeks | • Referred to immunoallergy and hematology department with moderately positive lupus anticoagulant • Diagnosed with APS with moderately positive lupus anticoagulant in the immunoallergy and hematology department • Lifelong anticoagulant therapy (warfarin) was recommended | |