25-year-old man with chest pain

Heart ◽  
2017 ◽  
Vol 104 (1) ◽  
pp. 72-72
Author(s):  
Dhara Singh ◽  
Rachana Bhat ◽  
Shyam S Kothari
Keyword(s):  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Heart Rate ◽  
Chest Pain ◽  
Acute Onset ◽  
Premature Coronary Artery Disease ◽  
History Of ◽  
Artery Disease ◽  
Diabetes Family History ◽  
Diabetes Family

Clinical introductionA 25-year-old man presented with complaints of acute-onset chest pain for 2 hours associated with diaphoresis and generalised weakness. He had history of smoking for 10 years. There was no history of hypertension, diabetes, family history of premature coronary artery disease or drug abuse. On evaluation, his heart rate was 76/min, blood pressure 130/90 mm Hg and oxygen saturation 97% on room air. Cardiovascular examination was normal. The ECG is shown in figure 1.Figure 1

Abstract 17234: Cisplatin Induced Coronary Artery Atherosclerosis Leading To St-elevation Myocardial Infarction: A Case Report

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Sheikh Bilal B Khalid ◽  
Javaria Mahmood
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Premature Coronary Artery Disease ◽  
Chemotherapeutic Regimen ◽  
History Of ◽  
St Elevation ◽  
Artery Disease

Introduction: Cisplatin-based chemotherapeutic regimen (CBCR) is known for increasing risk of venous thromboembolic (TE) disease. We report a unique case of STEMI associated with CBCR which we believe was caused by coronary artery thrombosis. Case description: A 31-yo man with a past history of germ cell tumor presented with chest pain radiating to back and left arm. It started this morning and intensity did not worsen with exertion. He denied any dyspnea, diaphoresis or palpitations. He was non-smoker and non-obese. He denied any family history of premature coronary artery disease. He had undergone unilateral orchiectomy a year ago, and was currently receiving chemotherapy with bleomycin, etoposide and cisplatin; the last dose of his 3 rd cycle was given the day before. EKG showed ST elevation in leads I, aVL, V4 and V5. Troponin I was high to 6.9 ng/ml (ULN 0.045 ng/ml). He received intravenous infusion of thrombolytic. An angiogram done the next day showed moderate mid-LAD disease with residual clot. A CT scan and an echocardiogram later showed left ventricular thrombus (LVT). He was kept on therapeutic enoxaparin along with aspirin. Follow up echocardiogram showed resolution of the thrombus. His chemotherapy was stopped, and he has been kept on active surveillance since then. Discussion: Most cases of CBCR-associated myocardial infarction that have been reported have been seen in the older population with other risk factors for coronary artery disease. Cases where angiographic data was available, coronary artery vasospasm appeared to be the culprit rather than a true plaque rupture. While the presence of LVT raises possibility of thromboembolism to coronaries causing MI, the angiographic findings support accelerated plaque formation to be the cause of infarction. In earlier reports, elevated pre-treatment level of von Willebrand factor has been postulated to have some role in the disease pathogenesis. Other possible mechanisms for pathogenesis include endothelial cell damage, platelet activation, and imbalance between thromboxane-prostacyclin levels. This case emphasizes the need to keep cardiac etiologies of chest pain in the differential when evaluating patients on CBCR as timely intervention is life saving and prevent morbidity.

Abstract 425: Coronary Artery Disease in Patients with Premature Atherosclerotic Peripheral Artery Disease

2012 ◽  
Vol 32 (suppl_1) ◽  
Author(s):  
Hamza Rana ◽  
Jeanette S Andrews ◽  
Kimberley J Hansen ◽  
Pavel J Levy
Keyword(s):  
Coronary Artery Disease ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Family History ◽  
Peripheral Artery ◽  
History Of ◽  
Premature Cad ◽  
Artery Disease ◽  
Diabetes Family History ◽  
Diabetes Family

Objective: Premature atherosclerotic peripheral artery disease (PAD) is being diagnosed with increasing frequency. Little is known about concomitant coronary artery disease (CAD) in patients with premature PAD. This study examines prevalence, associated clinical characteristics, and predictors of concomitant CAD in young PAD patients. Methods: We studied patients with severe atherosclerotic PAD <55 years of age (mean 49.36±6.45 yrs) treated at a single academic Vascular center between 1998 and 2010. Data was collected at the time of initial evaluation. CAD was defined by documented acute coronary syndrome; and/or prior coronary revascularizations. Associations with concomitant CAD were evaluated univariately using chi-square tests for categorical characteristics or t-tests for continuous characteristics, and using multivariable logistic regression. Results: Total of 561 patients (46% female, 20% Black) were analyzed. Mean age at diagnosis was 46.64±6.86 years. Risk factors included smoking (97%), hyperlipidemia (67%), hypertension (64%), family history of premature CAD (47%), and diabetes (25%). Aortoiliac disease was present in 77% of patients; 36% were disabled. Overall, 174 (31%) patients had clinical CAD. Patients with premature CAD were less likely to be Blacks (p=0.004), had greater frequency of hypertension, hyperlipidemia, diabetes, family history of premature CAD, polyvascular disease (i.e. cerebral vascular disease [CeVD]) (p<.001 for each), renovascular disease (p=.016) and mesenteric disease (p=.012). Multivariable logistic regression modeling showed higher odds of concomitant CAD for patients with hyperlipidemia (OR 4.71; 95 CI 2.82-7.85; p<.0001), diabetes (OR 2.11; 95% CI 1.28-3.47; p<0.01), family history of premature CAD OR 2.00; 95% CI 1.27-3.14;p<0.01) CeVD (OR 2.15; 95% CI 1.34-3.48;p<0.01), mesenteric vascular disease (OR 2.70;95% CI 1.19-6.14; p=.02). One pack year in smoking increase had 1.01 times odds of concomitant CAD (95% CI 1.001-1.018; p=.02). Conclusions: Clinical CAD was prevalent in 1/3 of patients with premature PAD, and those with premature CAD were less likely to be Black. Among patients with premature PAD, higher odds of concomitant clinical CAD were associated with presence of hyperlipidemia, diabetes, family history of premature CAD, polyvascular disease.

Small, Oral Dose of Clonidine Reduces the Incidence of Intraoperative Myocardial Ischemia in Patients Having Vascular Surgery

1996 ◽  
Vol 85 (4) ◽  
pp. 706-712 ◽  
Author(s):  
Klaus-Dieter Stuhmeier ◽  
Bernd Mainzer ◽  
Jochen Cierpka ◽  
Wilhelm Sandmann ◽  
Jorg Tarnow
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Heart Rate ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Oral Dose ◽  
Fluid Volume ◽  
Arterial Blood ◽  
Artery Disease

Background Most new perioperative myocardial ischemic episodes occur in the absence of hypertension or tachycardia. The ability of alpha 2-adrenoceptor agonists to inhibit central sympathetic outflow may benefit patients with coronary artery disease by increasing the myocardial oxygen supply and -demand ratio. Methods A randomized double-blind study design was used in 297 patients scheduled to have elective vascular surgical procedures to evaluate the effects of 2 micrograms/kg-1 oral clonidine (n = 145) or placebo (n = 152) on the incidence of perioperative myocardial ischemic episodes, myocardial infarction, and cardiac death. Continuous real-time S-T segment trend analysis (lead II and V5) was performed during anesthesia and surgery and correlated with arterial blood pressure and heart rate before and during ischemic events. Dose requirements for vasoactive and antiischemic drugs to control blood pressure and heart rate as well as episodes of myocardial ischemia (i.e., catecholamines, beta-adrenoceptor antagonists, nitrates, and systemic vasodilators) and fluid volume load were recorded. Results Administration of clonidine reduced the incidence of perioperative myocardial ischemic episodes from 39% (59 of 152) to 24% (35 of 145) (P &lt; 0.01). Hemodynamic patterns, percentage of ischemic time, and the number of ischemic episodes per patient did not differ. Nonfatal myocardial infarction developed after operation in four patients receiving placebo compared with none receiving clonidine (day 2 to 21; P = 0.07). The incidence of fatal cardiac events (1 vs. 2) was not different. Dose requirements for vasoactive and antiischemic drugs did not differ between the groups, but the amount of presurgical fluid volume was slightly greater in patients receiving clonidine (951 +/- 388 vs. 867 +/- 381 ml; P &lt; 0.03). Conclusion A small oral dose of clonidine, given prophylactically, can reduce the incidence of perioperative myocardial ischemic episodes without affecting hemodynamic stability in patients with suspected or documented coronary artery disease.

scholarly journals Melatonin for nondippers with coronary artery disease: assessment of blood pressure profile and heart rate variability

2009 ◽  
Vol 33 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Tomasz Rechciński ◽  
Ewa Trzos ◽  
Karina Wierzbowska-Drabik ◽  
Maria Krzemińska-Pakuła ◽  
Małgorzata Kurpesa
Keyword(s):  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Coronary Artery ◽  
Pressure Profile ◽  
Disease Assessment ◽  
Blood Pressure Profile ◽  
Artery Disease

Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

Cardiology ◽  
2015 ◽  
Vol 133 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Mathias Sørgaard ◽  
Jesper James Linde ◽  
Klaus Fuglsang Kofoed ◽  
Jørgen Tobias Kühl ◽  
Henning Kelbæk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Stress Test ◽  
Photon Emission ◽  
Acute Onset ◽  
Emission Computed Tomography ◽  
Artery Disease

Objectives: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We investigated the validity of the new guidelines in a population of patients with acute-onset chest pain. Methods: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA. Results: The diagnostic accuracy of PTP was significantly higher than the stress test (AUC 0.80 vs. 0.69; p = 0.009), but the diagnostic accuracy of the combination of PTP and a stress test did not significantly increase when compared to PTP alone (AUC 0.86 vs. 0.80; p = 0.06). Conclusions: PTP using the updated Diamond and Forrester Score is a very useful tool in risk-stratifying patients with acute-onset chest pain at a low-to-intermediate risk of having CAD. Adding a stress test to PTP does not appear to offer significant diagnostic benefit.

scholarly journals Control of blood pressure levels in patients with premature coronary artery disease: Results from the Genetics of Atherosclerotic Disease study

2020 ◽  
Vol 22 (7) ◽  
pp. 1253-1262 ◽  
Author(s):  
Esteban Jorge‐Galarza ◽  
Froylan D. Martínez‐Sánchez ◽  
Cesar I. Javier‐Montiel ◽  
Aida X. Medina‐Urrutia ◽  
Carlos Posadas‐Romero ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Atherosclerotic Disease ◽  
Premature Coronary Artery Disease ◽  
Artery Disease ◽  
Disease Study

scholarly journals The Interplay of Exercise Heart Rate and Blood Pressure as a Predictor of Coronary Artery Disease and Arterial Hypertension

2012 ◽  
Vol 15 (3) ◽  
pp. 162-170 ◽  
Author(s):  
Andreas P. Michaelides ◽  
Charalampos I. Liakos ◽  
Gregory P. Vyssoulis ◽  
Evangelos I. Chatzistamatiou ◽  
Maria I. Markou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Heart Rate ◽  
Coronary Artery ◽  
Arterial Hypertension ◽  
Exercise Heart Rate ◽  
Artery Disease
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