A case report of shingles and subsequent cardiac ischaemia in a young male

A type 1 non-ST-segment elevation myocardial infarction (NSTEMI) is a rare complication of shingles infection, especially in young individuals with few predisposing risk factors.

A 39-year-old man, who was successfully treated for herpes zoster meningitis and encephalitis 3 months before this hospitalization, presented to the emergency department with worsening chest pain that radiated to his back with associated shortness of breath. Based on elevated troponin and abnormalities seen on electrocardiogram and transthoracic echocardiogram, the patient was diagnosed with a type 1 NSTEMI. A left heart catheterization was performed, resulting in a drug-eluting stent to the left anterior descending ostium. He was discharged with oral aspirin 81 mg daily, oral ticagrelor 90 mg twice daily, and oral rosuvastatin 20 mg daily.

Infection with herpes zoster virus (HZV) has been temporally associated with increased risk of cardiovascular disease, even in those who are young with few predisposing risk factors. It has been postulated that HZV infection causes inflammation, subsequent hypercoagulability, vessel ischaemia, and arterial remodelling. More research needs to be conducted to further understand the possible mechanisms of action of HZV infection’s effect on the heart.