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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 3, May/June 2015
AFRICA
e3
have demonstrated that maintenance of normoglycaemia with
intensive insulin therapy may reduce morbidity and mortality
rates in critically ill patients.
9,10
The case reported here represents true myocardial infarction,
based on the changes in cardiac enzyme levels, as well as
echocardiographic and ECG findings. To our knowledge, this is
the first reported case of SIRS-induced myocardial infarction.
Different from previous reports, there was no relevant coronary
stenosis in this case, as shown by the coronary angiography and
IVUS (Fig. 2).
A new clinical classification of myocardial infarction was
proposed in the 2007 ESC/ACCF/AHA/WHF consensus
conference,
11
and clinically various types of myocardial
infarction were classified by pathogenesis, as described in
Table 1. In the present case, the myocardial infarction should
be classified as type 2, and cardiac damage induced by SIRS is
likely to be the most probable mechanism of acute myocardial
infarction. Additionally, a hypodynamic circulation, especially
one reflected in a notable reduction in the ejection fraction
(32%) by echocardiography, as in this case, may also be related
to myocardial infarction.
In recent years, many researchers have suggested that local
and systemic inflammation may play an important role in the
occurrence, development and complications of acute coronary
syndrome (ACS).
12
However, coronary angiography is essential
to avoid the potentially lethal consequences of thrombolytic
therapy in this type of myocardial infarction.
In summary, according to the results of glycated haemoglobin
and the patient’s medical history, we may infer that the patient
had a medical history of diabetes that was not well controlled.
Pneumonia infection was induced by diabetes; therefore, we
speculated that the patient developed SIRS secondary to
diabetes-induced infection. As a result, a large number of
inflammatory factors, including C-reactive protein, may have
damaged the patient’s pancreas, heart, liver, kidney and skeletal
muscle, leading to MODS.
Conclusion
The present case demonstrates that SIRS may lead to multiple
organ damage, and even to a clinical performance of coronary
artery disease mimicking acute myocardial infarction. Urgent
diagnosis by angiography is required. To enable prompt
diagnosis and effective treatment in similar cases, clinicians
should be aware of this type 2 myocardial infarction. Patients
who smoothly obtain an inflammatory reaction peak under
active treatment will likely experience good results.
No external financial support was provided. We thank the patient for his
cooperation and for providing the photographic material.
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Table 1. Clinical classification of myocardial infarction (MI), as
proposed at the 2007 ESC/ACCF/AHA/WHF consensus conference
Type of MI Description
Type 1
Spontaneous MI related to ischaemia due to a primary
coronary event such as plaque erosion and/or rupture,
fissuring or dissection
Type 2
MI secondary to ischaemia due to either increased oxygen
demand or decreased supply, e.g. coronary artery spasm,
coronary embolism, anaemia, arrhythmias, hypertension
or hypotension
Type 3
Sudden unexpected cardiac death
Type 4a MI associated with primary percutaneous coronary inter-
vention (PPCI)
Type 4b MI associated with stent thrombosis as documented by
angiography or at autopsy
Type 5
MI associated with coronary artery bypass grafting (CABG)