BACKGROUND: Prolonged exposure to high altitude can increase the risk of coronary artery disease, acute coronary syndrome, and other ischemic cardiovascular events. This report describes the case of a 34-year-old man with exercise-induced ST-segment elevation myocardial infarction (STEMI) 36 hours after descent from high altitude.

CASE REPORT: A previously healthy 34-year-old man presented with 9 hours of crushing substernal chest pain. Electrocardiogram (ECG) demonstrated anteroseptal ST-segment elevation in leads V1-V3 with reciprocal changes in inferior leads. Emergency coronary angiography (CAG) revealed total occlusion with a high thrombus burden of the proximal left anterior descending (LAD) artery with TIMI 0 flow, accompanied by diffuse non-culprit coronary plaques (30-40% stenosis). Primary percutaneous coronary intervention (PCI) with drug-eluting stent implantation restored TIMI 3 flow. The event occurred 36 hours after descent from 4200 m altitude, immediately following intensive exercise, suggesting a temporal association between early de-acclimatization and acute coronary events.

CONCLUSIONS: Multiple factors, including dyslipidemia, residual hemorheological changes after high-altitude exposure, and vigorous exercise, may be associated with the occurrence of acute myocardial infarction (AMI) during high-altitude de-acclimatization. This report highlights the importance of recognizing that patients with a history of living at high altitude can be at increased risk of acute coronary syndromes, particularly ST-segment elevation myocardial infarction, when undertaking exercise.

Keywords: Coronary Angiography, acute myocardial infarction, high altitude, Exercise, case report