Acute coronary syndrome as a current issue of pediatric cardiology. Outcomes and prognosis: Clinical case

Background. Acute coronary syndrome is widespread in the adult population and has clear diagnostic criteria. In pediatric practice, this pathology is rare, and often implies difficulties in diagnosis. Case description. A 16-year-old male with negative paternal history, hypercholesterolemia, dyslipidemia, and excessive body weight developed myocardial infarction on the background of acute tonsillitis. In the onset of the disease, the adolescent demonstrated clinical signs of acute respiratory infection and coronary spasm. Electrocardiogram revealed ST segment elevation above the baseline in leads I, II, III, aVF, V₄–V₆ and biochemical markers of myocardial necrosis. Echocardiography revealed signs of focal hypokinesis of the left ventricle, newly detected degree 2 mitral regurgitation. Percutaneous coronary angiography revealed no signs of coronary artery stenosis. The patient received conventional medical treatment of acute myocardial infarction as well as antibacterial therapy. He was discharged in satisfactory condition. After 1 year of follow-up after the myocardial infarction the patient showed no pathologic changes both on stress-echocardiography and electrocardiogram. Three-year catamnesis appeared to be favorable. Conclusion. The presented clinical case demonstrates the individual mechanism of acute coronary syndrome development in children. Pediatricians should be aware of the risk of developing acute coronary syndrome against the background of infectious pathology.

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