Miliary Tuberculosis and Acute Myocardial Infarction with left ventricular aneurysm in a 73 year old male seen at the National Hospital in Timor-Leste: A case report

Abstract

Background: The developing world is currently facing a double epidemic of communicable and non-communicable diseases. There is a growing body of knowledge recognizing an interaction between the two epidemics. Here we report a case of active pulmonary tuberculosis and acute myocardial infarction. Case presentation: A 73 year old male who had recently been diagnosed with hypertension but with an otherwise unremarkable past medical history presented to the emergency department of the Timor-Leste National Referral Hospital with chest pain and shortness of breath of one weeks duration. There was a positive history of intermittent fever, dry cough and weight loss over the preceding 3-4 weeks. His 12-lead electrocardiogram showed ST-segment elevation in the inferior leads and chest X-ray was characteristic of miliary tuberculosis. Echocardiography showed low ejection fraction and left ventricular inferior wall aneurysm. Cardiac enzymes as well as cardiac catheterization were not available in the hospital. He was managed with medical therapy for myocardial infarction without reperfusion therapy. He initially showed improvement in his clinical parameters (Chest pain, Heart rate, Blood pressure, Oxygen saturations, and fever) but succumbed to sudden cardiac arrest after 10 days of hospital admission. Post mortem examination was not done. Conclusion: The presentation of acute myocardial infarction in this patient with active tuberculosis and an otherwise benign past medical history is in support of reports that tuberculosis plays an active role in the pathogenesis of acute myocardial infarction in some patients presenting with these two diseases.