RESUMO
A 55-year-old man with history of alcoholism presented to our hospital complaining of severe substernal chest pain. After a series of tests and procedures, a large mobile thrombus occupying the left coronary cusp with extension into the ascending aorta was discovered. The patient's hemodynamics remained unstable. After 6 hours of resuscitation, his hemodynamics could not be maintained and eventually, he expired. The autopsy result revealed an ascending aortic aneurysm with atheromatous plaques and focal ulceration without thrombus in the aneurysm. The pathological report showed evidence of acute anterior myocardial infarction, aneurysm with endarteritis and plasma cell infiltration, as well as atherosclerosis with ulcerative plaque. These findings were compatible with syphilitic aortitis. Tertiary syphilis is rarely encountered in current medical practice. Thrombus in the ascending aorta occluding the left coronary artery ostia and resulting in coronary embolus into the left anterior descending is a rare cause of acute anterior ST-segment-elevation myocardial infarction. The combination of these rare causes raises special attention to early recognition of thrombus forming from the syphilitic aortic aneurysm in the ascending aorta propagating to the coronary artery as a cause of myocardial infarction.