Embolic renal infarction in a patient with NSTEMI

Introduction: The association between renal infarc-tion and myocardial infarction (MI) is rare. The most common etiology of this pathology is cardio-embolic, notably in the setting of atrial fibrillation.

Methods: A 70-year-old male patient, with important cardiovascular risk factors (smoker, hypertensive and dyslipidemic) was transferred to our hospital for ur-gent renal angiography, with the suspicion of left renal infarction diagnosed by a previous AngioCT scan. He mentioned a 72-hours history of chest pain radiating in the left flank. At admission in our unit the physi-cal examination revealed high blood pressure (150/80 mmHg), normal cardiac and pulmonary examination and diffuse left flank pain. The cardiac necrosis mar-kers and the serum lactate dehydrogenase were eleva-ted. The renal function was within normal limits. The electrocardiogram showed sinus rhythm with a paro-xysmal atrial fibrillation episode and anterior sub-en-docardial ischemia. The echocardiography illustrated left ventricle apical aneurysm and hypokinesia of the anterior, inferior and infero-septal walls.

Results: Based on the information presented above, the patient was diagnosed with a subacute non-ST-eleva-tion myocardial infarction and renal infarction. Con-sequently, a coronarography together with a renal an-giography were indicated. The coronarography show-ed 3-vessels disease: critical lesions of distal common trunk, the proximal left anterior descending and the 2nd segment of the circumflex coronary arteries and a chronic occlusion of the right coronary artery. The con-comitant renal arteriography found a chronic complete occlusion of the left renal artery, with no percutaneous revascularization solution at this time, in the presen-ce of nonfunctional left kidney. The patient’s condition gradually improved with optimal medical therapy. A week later, the patient was discharged on antithrombo-tic therapy, with a clear indication of delayed surgical revascularization. Considering the gravity of the coro-nary disease, the surgical myocardial revascularization was the optimal option for this patient. In absence of severe angina, the heart team decided for elective surgi-cal intervention at least 21 days after the subacute renal and cardiac events, in order for the patient to maintain the clinical and biological stability.

Conclusions: This case illustrates that in patients with embolic renal infarction, clinical presentation can be misleading, especially when they associate myocardial ischemia and paroxysmal atrial fibrillation, causing a delay in the diagnosis and treatment, which can influ-ence the outcomes.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)