Management of Acute Myocardial Infarction in a Liver Transplant Recipient- A rare case report

Abstract

Abstract Liver transplantation (LT) improves outcomes and quality of life in patients with end-stage liver disease (ESLD). As a result of improved accessibility and recipient survival, transplant candidates are becoming increasingly older, have more co-morbidities, and experience more long-term complications, all of which created new challenges in post-transplantation care. In post-transplant period, a multitude of factors can influence cardiovascular risk in transplant recipients due to aggravation in recipient populations from new-onset dyslipidemia, hypertension, glucose intolerance, and nephrotoxicity as side effects of immunosuppressive agents. Traditional cardiovascular risk factors are becoming increasingly prevalent in the aging population of Liver Transplant candidates, and coronary artery disease is considered to be more common than previously thought. Cardiovascular events are recognized as prominent causes of early and late mortality in liver transplant recipients The most common cardiovascular diseases in transplant candidates are ischemic coronary artery disease (CAD) and cardiomyopathy. We describe a complex case of liver transplant recipient in a 50-year-old male patient with no known history of coronary artery disease who developed progressive acute myocardial infarction within 6 months of liver transplant, ultimately thrombolysed to optimize myocardial perfusion. Management of myocardial ischemia was complicated by high risk of bleeding in the setting of coagulopathy. Once thrombolysed and hemodynamic stability was achieved, the patient immediately shifted for coronary angiography and staged coronary angioplasty was done for triple vessel coronary disease in patient at cardiac institute.