Abstract
Homocysteine is sulfur containing intermediary amino acid formed by the demethylation of dietary methionine to cysteine. The raised serum homocysteine level is one of the important risk factors associated with coronary artery disease. We present a 23-year-old male with no other risk factors of coronary artery disease presented to us with acute anterior wall myocardial infarction and was treated with primary percutaneous coronary intervention. During the routine work up post percutaneous coronary intervention significant elevation of serum homocysteine level was seen with markedly low serum vitamin B12 level and was treated for it along with standard therapy for acute myocardial infarction. The case illustrates the need to incorporate a plasma homocysteine level during work up of coronary artery disease especially in young patients, more importantly in those without any conventional risk factors.
Highlights
The intracellular metabolism of dietary methionine to cysteine releases homocysteine as an intermediate product
We present a 23-year-old male with no other risk factors of coronary artery disease presented to us with acute anterior wall myocardial infarction and was treated with primary percutaneous coronary intervention
During the routine work up post percutaneous coronary intervention significant elevation of serum homocysteine level was seen with markedly low serum vitamin B12 level and was treated for it along with standard therapy for acute myocardial infarction
Summary
The intracellular metabolism of dietary methionine to cysteine releases homocysteine as an intermediate product. This metabolism requires folic acid, vitamin B12 and vitamin B6 [1]. Hyperhomocysteinemia is one of the rare and independent causes of acute coronary syndrome It leads to accelerated atherosclerosis by multiple mechanisms and has to be considered when we encounter coronary artery disease especially in young individuals without conventional risk factors. The metabolism of Homocysteine requires vitamin B12, B6 and folic acid It makes the assessment of Serum Vitamin B12, B6 and Folic acid and their supplementation in cases where we strongly suspect Hyperhomocysteinemia as a potential cause of coronary artery disease
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