A Case of Acute Myocardial Infarction and Cerebral Infarction Associated with Metastatic Pancreatic Carcinoma

Acute myocardial infarction without angiographic evidence of arteriosclerosis is uncommon. We report the case of a 63-year-old female patient with acute myocardial infarction. Coronary angiography showed thrombotic total occlusion in the mid left anterior descending artery and thrombotic critical stenosis in the proximal left circumflex artery. Despite multiple balloon angioplasty and aspiration of thrombi, distal flow in the left anterior descending and left circumflex arteries only improved slightly, because abundant thrombi remained. No residual stenosis was observed on angiography. However, computed tomography of the abdomen showed a 5-cm low-attenuated mass with a peripheral enhanced rim in the pancreas and a maximal 7-cm multiple ill-defined peripheral enhanced low-attenuated mass in the liver. Unfortunately, the patient experienced multiple embolic cerebral infarctions 7 days later. The patient had no relevant cardiovascular disease risk factors, signs of heart failure, or arrhythmia. We believe that the pathogenetic mechanism responsible for myocardial infarction in this patient was in situ thrombosis.