Acute myocardial infarction in patient without cardiac risk factors during emergence from general anesthesia: a case report

BACKGROUND: Perioperative myocardial infarction is a rare but highly fatal complication, which often occurs in patients with poor preoperative cardiac conditions undergoing high-risk surgery. We report a case of acute myocardial infarction in a patient without cardiac risk factors during emergence from general anesthesia for removal of spinal screws. CASE PRESENTATION: A 37-year-old, 60 kg, and 160 cm man, who had no history of cardiovascular diseases, underwent removal of loosen spinal plug screws at L4-L5. The preoperative investigations revealed no abnormality and the patient was ASA I. The surgery was uneventful. During aspiration of the endotracheal tube, the patient suddenly experienced paroxysmal atrial fibrillation and ST segment elevation in DII lead. He was treated with oxygenation, optimal hemodynamics, minimize cardiac work, antiarrhythmias, and anticoagulation. The clinical conditions improved. Sinus rhythm was regained after 24 h and discharged without complications. CONCLUSIONS: Myocardial infarction can occur suddenly and unexpectedly in patients without risk factors after a low-risk surgery in any period of general anesthesia. Close monitoring and prompt treatment with this condition is important for improving outcomes.