A 20-year-old male patien...

A 20-year-old male patient was admitted to the emergency room with complaints of acute chest pain. He was an active smoker with a medical history of acute ST-elevation myocardial infarction (MI). His ICA and CCTA showed multiple intracoronary thrombi and distal emboli in the LAD, RCx, and in smaller branches of the LCA. His high-sensitive troponin-T and creatinine kinase levels are significantly elevated. On day 3, his CMR revealed akinesia with an LVEF of 47%. His DE-CMR showed two distinct patterns of hyperenhancement, including a typical transmural MI and multiple atypical mid-wall and epicardial areas of focal 15 hyperenhancement, which perfectly matched the distribution territories of the affected coronary arteries. He was initiated on low-molecular-weight heparins. He remained asymptomatic during admission and was discharged on triple antithrombotic therapy of aspirin, clopidogrel, and vitamin K antagonist for one month, followed by clopidogrel and a vitamin K antagonist.