Abstract 17117: Hyperhomocysteinemia Associated St Elevation Myocardial Infarction In A Young Male

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Omar Sheikh ◽  
Jennifer Mustard ◽  
Muhammad Osman ◽  
Harsh Golwala
Keyword(s):  
Risk Factor ◽  
Vascular Disease ◽  
Plaque Rupture ◽  
Young Male ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Atherosclerotic Vascular Disease ◽  
Aspiration Thrombectomy ◽  
Catheterization Laboratory ◽  
Lipid Rich Plaque

Case Presentation: A 24-year-old male with a medical history of Crohn’s on mesalamine presented to the emergency room with crushing substernal chest pain at rest. Electrocardiogram revealed ST elevations in Lead V2-V5 (Figure-1a). He was taken emergently to the catheterization laboratory and had 100% thrombotic occlusion of his proximal left anterior descending coronary artery (LAD) (Figure-1b). Intravascular ultrasound (IVUS) confirmed the presence of soft atheromatous lipid-rich plaque in the proximal LAD with heavy thrombus burden (Figure-1c/d). He underwent aspiration thrombectomy and IVUS guided percutaneous coronary intervention with a 4.5 mm x 32 mm drug-eluting stent. Echocardiogram revealed an akinetic anterior wall with an ejection fraction of 35% without a patent foramen ovale. Hypercoagulable workup was initiated and showed a significantly elevated homocysteine level of 84.4 umol/L (normal:3.5-10.4). Family history, drug screen, hemoglobin A1C, and lipid profile were unremarkable. Discussion: The differential diagnosis in a young male presenting with a STEMI includes thromboembolism versus plaque rupture. IVUS showed clear evidence of a lipid-rich plaque demonstrating premature atherosclerotic vascular disease rather than a thromboembolic event. His most striking risk factor was hyperhomocysteinemia with a level of 84.4 umol/L. Elevations in homocysteine plasma concentration has been identified as an independent risk factor for atherosclerosis due to its atherogenic and prothrombotic properties. To date lowering homocysteine levels with folate and additional therapies have not shown to reduce the risk of coronary disease. Our case stresses the importance of intravascular imaging, especially in atypical cases such as a young male presenting with a STEMI to differentiate plaque rupture versus thromboembolism. Further studies are needed to identify risk modifying therapies for hyperhomocysteinemia associated vascular disease.

scholarly journals Outcomes of primary percutaneous coronary intervention (PCI) in NICVD, Dhaka,Bangladesh- our initial experiences

2015 ◽  
Vol 9 (2) ◽  
pp. 83-87 ◽  
Author(s):  
Mir Jamaluddin ◽  
Ibrahim Khalil ◽  
Kajal Kumar Karmakar ◽  
Humayun Kabir ◽  
Rakibul Islam Litu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Positive Family History ◽  
Coronary Intervention ◽  
Bare Metal Stent ◽  
Drug Eluting Stent ◽  
Primary Pci ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Percutaneous Coronary

The aim of the study is to determine the out comes of primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction in NICVD the only government cardiac hospital of Bangladesh where resources are very limited. Total 73 (male 70, female 3) patients were enrolled in this study who were brought in to our hospital with STEMI between August 2010 to October 2013. Average age was 55.6 ±11.78. Primary PCI was performed after transferring patient from Emergency Department to cardiac catheterization laboratory. Cardiovascular risk factors among the studied population were Diabetes mellitus, Hypertension, Smoking, Dyslipidemia and Positive family history for IHD. Primary PCI either with Bare Metal Stent (BMS) or Drug Eluting Stent (DES) were performed in total 42 LAD lesions, 28 RCA lesions and 3 LCX lesions. BMS used were 87.7%, DES used were 12.3%. The procedural success was 95.8%.Four patients (5.4%) died during hospital stay. Out of four patients who died, one had cardiogenic shock. No mortality was observed in the 30 days follow up from discharge, while other complications like unstable angina and congestive heart failure were 5.7% and 4.3% respectively. Our findings suggest favorable outcomes, matching the international data which was achieved in our patients with primary PCI in the management of STEMI despite all the limitations. Primary PCI as a preferred method of reperfusion strategy needs to be practiced more often in our part of world.University Heart Journal Vol. 9, No. 2, July 2013; 83-87

Is homocysteinaemia a risk factor for venous thrombosis and atherosclerotic vascular disease?

The Lancet ◽  
1995 ◽  
Vol 346 (8967) ◽  
pp. 127 ◽  
Author(s):  
MaríaJosé Medrano ◽  
MaríaJesús Barrado ◽  
Javier Almazán
Keyword(s):  
Risk Factor ◽  
Venous Thrombosis ◽  
Vascular Disease ◽  
Atherosclerotic Vascular Disease

Serially increasing change in lipoprotein(a) concentration has predictive value in acute vascular events

2005 ◽  
Vol 42 (4) ◽  
pp. 285-291 ◽  
Author(s):  
Soon Jun Hong ◽  
Hong Seog Seo ◽  
Chang Gyu Park ◽  
Seung Woon Rha ◽  
Dong Joo Oh ◽  
...  
Keyword(s):  
Risk Factor ◽  
Relative Risk ◽  
Vascular Disease ◽  
Predictive Value ◽  
Arterial Disease ◽  
Atherosclerotic Vascular Disease ◽  
Vascular Events ◽  
Lipoprotein A ◽  
Peripheral Arterial

Background: Lipoprotein(a) (Lp(a)) has been regarded in some studies as an independent risk factor of atherosclerotic vascular disease. However, the use of a baseline plasma Lp(a) concentration as a screening tool for future acute vascular events (AVE) is controversial. We therefore investigated whether progressively increasing change in plasma Lp(a) concentration is associated with the development of AVE. Methods: We investigated prospective analyses of 985 participants (464 women and 521 men) who had either clinically evident vascular disease (VD group, n=443) or its risk factor(s) (RF group, n=542). Blood samples were taken from all participants every six months to measure inflammatory markers such as Lp(a) and C-reactive protein during a 10-year follow-up period. Results: During the follow-up, 223 new cases of myocardial infarction, stroke, and peripheral arterial disease were identified. In the RF group, the relative risk of positive ∆ Lp(a) for predicting AVE was 4.36 (95% confidence interval [CI] 1.76-10.85; P=0.002). In the VD group, the relative risk of positive ∆ Lp(a) for predicting AVE was 6.35 (95% CI 3.68-10.97; P<0.001). Conclusions: These results suggest that a progressively increasing change in Lp(a) concentration has a highly significant predictive value in AVE in both the VD and the RF groups.

Statement on Cholesterol

PEDIATRICS ◽  
1992 ◽  
Vol 90 (3) ◽  
pp. 469-473 ◽  
Author(s):  
Keyword(s):  
Risk Factor ◽  
Family History ◽  
Vascular Disease ◽  
Children And Adolescents ◽  
Dietary Fat ◽  
Blood Cholesterol ◽  
Atherosclerotic Vascular Disease ◽  
Cholesterol Levels ◽  
Coronary Vascular Disease ◽  
Obesity And Diabetes

Increased blood cholesterol levels have been found to be a risk factor for coronary vascular disease in adult populations, and the reduction of cholesterol levels in adults decreases the risk. Because no comparable studies have been carried out in childhood populations, the significance of cholesterol as a risk factor for coronary vascular disease must be inferred from less direct evidence. It is also important to note that a number of other factors including cigarette smoking, hypertension, obesity, and diabetes mellitus are important in their causative relationship to atherosclerotic vascular disease. A family history of premature coronary vascular disease is also a risk factor for early onset coronary vascular disease. The American Academy of Pediatrics (AAP) last published its recommendations regarding dietary fat and cholesterol in 19861 and suggested indications for cholesterol testing in children and adolescents in 1989.2 Very recently the Expert Panel on Blood Cholesterol Levels in Children and Adolescents of the National Cholesterol Education Program (NCEP), in a comprehensive report, recommended that all children and adolescents eat a diet that on average contains no more than 30% of total calories from fat, less than 10% of total calories from saturated fat, and less than 300 mg of cholesterol per day.3 The panel recommended screening blood cholesterol levels only in those children and adolescents whose risk of developing coronary vascular disease as adults could be identified by family history or by the coexistence of several risk factors. In this statement the earlier recommendations of the AAP are reviewed in the context of the recent NCEP report and provide current guidelines regarding dietary fat and cholesterol, cholesterol screening, and management of elevated blood cholesterol levels in children.

scholarly journals Study on Primary Percutaneous Coronary Intervention (PCI) in Patient with Acute Myocardial Infarction: In-Hospital and 30-days Survival Outcome

1970 ◽  
Vol 2 (2) ◽  
pp. 212-217 ◽  
Author(s):  
AQM Reza ◽  
AHMW Islam ◽  
S Munwar ◽  
S Talukder
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Setting ◽  
Coronary Intervention ◽  
Anterior Wall ◽  
Survival Outcome ◽  
Drug Eluting Stent ◽  
Primary Pci ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory

Objective: Aim of our study was to evaluate the safety and survival outcome of Primary PCI (pPCI) in patients with Acute Myocardial infarction in our hospital setting. Methods: Total 30 (Female 5; Male 25) patients were enrolled in this study who were brought in to our hospital with STEMI. Average age was, Male 56, Female 52. Primary PCI was performed after transferring patient from Emergency Department (ED) to Cardiac Catheterization laboratory. Cardiovascular risk factors among the studied population were Dyslipidemia, Diabetes Mellitus, Hypertension, Smoking and Family History. Results: Primary PCI either with Bare Metal Stent (BMS) or Drug Eluting Stent (Sirolimus-eluting stent or Paclitaxel stent) were performed in total 13 LAD lesion and 15 RCA lesion and 2 LCX lesion. BMS used were 66.7%, Sirolimus 20% and Paclitaxel-eluting stent 13.3%. Total 2 patients expired but due to hemorrhagic CVA and refractory heart failure. At presentation, ECG evidenced diagnosis were Acute Anterior Wall MI : 12 (40%), Inferior MI: 16 (53%), Infero-Posterior MI: 2 (6.7%). Our study showed that Primary PCI increases the higher survival outcome 28 (93.3%) out of 30 patients with acute MI. Conclusion: Our present study revealed that revascularization by Primary PCI showed safety and better percentage of In-hospital and 30-days survival outcome in patients with Acute myocardial infarction in our hospital setting. Keywords: Primary PCI; STEMI. DOI: 10.3329/cardio.v2i2.6641Cardiovasc. j. 2010; 2(2) : 212-217

Mild hyperhomocysteinemia: risk factor or just risk predictor for cardiovascular diseases?

VASA ◽  
2004 ◽  
Vol 33 (4) ◽  
pp. 191-203 ◽  
Author(s):  
Weiss ◽  
Hilge ◽  
Hoffmann
Keyword(s):  
Risk Factor ◽  
Vascular Diseases ◽  
Coronary Intervention ◽  
Vitamin Supplementation ◽  
Atherosclerotic Vascular Disease ◽  
Vascular Events ◽  
Plaque Area ◽  
Clinical Benefits ◽  
Risk Predictor ◽  
Mild Hyperhomocysteinemia

Elevated plasma levels of homocysteine (hyperhomocysteinemia) are increasingly recognized as a potential risk for atherothrombotic vascular diseases by numerous epidemiological and clinical studies. There are increasing experimental data that indicate mechanisms by which homocysteine may alter the vasculature in a way that predisposes to atherosclerotic vascular disease. A key event in the vascular pathobiology of hyperhomocysteinemia seems to involve the induction of endothelial dysfunction due to a reduction of the endogenous antiatherothrombotic molecular nitric oxide. Elevated homocysteine levels can be efficiently and safely reduced in most of hyperhomocysteinemic patients by supplementation of folic acid and cobalamin. This reduction is associated with an improvement in endothelial function and other surrogate markers of atherothrombosis, like carotid plaque area and the rate of abnormal stress electrocardiograms. Whether or not this translates into clinical benefits, is still under investigation. The first clinical study on homocysteine-lowering vitamin supplementation in patients that had undergone coronary intervention showed a benefitial effect on the rate on restenosis and the need for revascularization which translated into a reduction of major coronary events. In contrast, in three larger scaled secondary intervention trials in patients with stable coronary disease or post non-disabling stroke, vitamin supplementation had no effect on future vascular events although baseline homocysteine levels were significantly associated with a worse prognosis. Until the results of more clinical trials are available, the clinical relevant question whether or not homocysteine is just a risk predictor or a modifiable risk factor can not definitely be answered.

scholarly journals PERIODONTAL AND CARDIOVASCULAR DISEASES

2014 ◽  
Vol 10 (6) ◽  
pp. 4-9 ◽  
Author(s):  
Петер Ван дер Бийль ◽  
Peter Van der Biyl'
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Diseases ◽  
Periodontal Disease ◽  
Vascular Disease ◽  
Disease Diagnosis ◽  
Atherosclerotic Vascular Disease ◽  
The Relationship

<p>The relationship between periodontal and cardiovascular diseases is addressed in this article. Both these diseases have an inflammatory basis. Because periodontal disease is a risk factor for developing atherosclerotic vascular disease, diagnosis of the former is important. Particular attention must be paid to patients who have periodontal disease with other risk factors for atherosclerotic vascular disease. Recommendations managing these patients have been made included. </p>

Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention-Our Experiences at a Tertiary Hospital

2014 ◽  
Vol 6 (2) ◽  
pp. 107-111
Author(s):  
S Munwar ◽  
AHMW Islam ◽  
S Talukder ◽  
AQM Reza ◽  
T Ahmed ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Bare Metal ◽  
Coronary Artery Diseases ◽  
Left Main ◽  
Percutaneous Coronary ◽  
Drug Eluting

Background: Aim of the study was to evaluate the primary procedural success of percutaneous coronary intervention of unprotected left main coronary artery stenosis using either Bare-metal stents or drug eluting stent. Methods: Total 33 patients were enrolled in this very preliminary non-randomized prospective cohort study. Among them, Male: 25 and Female: 8. Total 35 stents were deployed. Mean age were for Male: 59 yrs, for Female: 62 yrs. Associated coronary artery diseases risk factors were dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive family history for coronary artery diseases and smoking. Results: Among the study group; 26 (78%) were Dyslipidemic, 24(70%) were hypertensive; 17 (51.5%) patients were Diabetic, 11(33%) were smoker and 7(21%) patients had family history of Ischaemic heart disease. Female patients were more obese (BMI M 26: F 27) and developed coronary artery diseases in advance age. Common stented territory were left main: 20 (60%), Left main to left anterior descending artery 7 (22%) and Left main to left circumflex artery 6 (18%). Average length and diameter of stent was 3.5 and 18 mm respectively. Stent used: Bare Metal Stent 5 (15%), Drug Eluting Stent: 28 (85%). Among the different Drug Eluting Stents, Everolimus eluting stents were 11 (39.3%), Sirolimus eluting 10(35.7%), Paclitaxel eluting 3 (10.7%), Biolimus eluting 3 (10.7%) and Zotarolimus eluting1 (3.6%). In the present study, overall survival outcome was 94% (31 patient), mortality of cardiac cause 3% (1 patient) and 1 patient (3%) died of hepatocellular carcinoma. Conclusion: Our study has shown that percutaneous coronary intervention of the unprotected left main is a safe and effective alternative to Coronary Artery Bypass Graft (CABG). DOI: http://dx.doi.org/10.3329/cardio.v6i2.18349 Cardiovasc. j. 2014; 6(2): 107-111

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