Non-ST Elevation Myocardial Infarction and Severe Peripheral Artery Disease in a 20-Year-Old with Perinatally Acquired Human Immunodeficiency Virus Infection.

Purva Sharma,Kleper De Almeida,Robert Chait,Rashida Tharpe,Mohamad Kabach,Samineh Sehatbakhsh,Shaun Isaac

doi:10.1155/2018/7803406

Purva Sharma, Kleper De Almeida + Show 5 more

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https://doi.org/10.1155/2018/7803406

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Abstract

Human immunodeficiency virus (HIV) infection confers an increased risk of cardiovascular disease, including acute coronary syndrome (ACS). Patients with perinatally acquired HIV may be at increased risk due to the viral infection itself and exposure to HAART in utero or as part of treatment. A 20-year-old female with transplacentally acquired HIV infection presented with symptoms of transient aphasia, headache, palpitations, and blurry vision. She was admitted for hypertensive emergency with blood pressure 203/100 mmHg. Within a few hours, she complained of typical chest pain, and ECG showed marked ST depression. Troponin I levels escalated from 0.115 to 10.8. She underwent coronary angiogram showing 95% stenosis of the right coronary artery (RCA) and severe peripheral arterial disease including total occlusion of both common iliacs and 95% infrarenal aortic stenosis with collateral circulation. She underwent successful percutaneous intervention with a drug-eluting stent to the mid-RCA. Patients with HIV are at increased risk for cardiovascular disease. Of these, coronary artery disease is one of the most critical complications of HIV. Perinatally acquired HIV infection can be a high-risk factor for cardiovascular disease. A high degree of suspicion is warranted in such patients, especially if they are noncompliant to their ART.

Highlights

Human immunodeficiency virus (HIV) infection is associated with an increased risk of cardiovascular disease through various mechanisms including premature atherosclerosis from endothelial inflammation and platelet dysfunction as well as from cART therapy involving protease inhibitors resulting in dyslipidemia and insulin resistance [1]
We present a case of a 20-year-old African American female who acquired HIV infection through transplacental transmission and presented to us with acute coronary syndrome (ACS)
Post et al studied the association between HIV infection and subclinical atherosclerosis through CT angiography. ey found that coronary artery plaque, especially noncalcified plaque, is more prevalent and extensive in HIV-infected men, independent of CAD risk factors [6]

Summary

Introduction

Human immunodeficiency virus (HIV) infection is associated with an increased risk of cardiovascular disease through various mechanisms including premature atherosclerosis from endothelial inflammation and platelet dysfunction as well as from cART therapy involving protease inhibitors resulting in dyslipidemia and insulin resistance [1]. One of the most important cardiac presentations is coronary artery disease leading to acute coronary syndrome (ACS). Patients with perinatally acquired HIV infection may be at an increased cardiac risk due to a combination of in utero HIV exposure and long-term exposure to cART [2]. We present a case of a 20-year-old African American female who acquired HIV infection through transplacental transmission and presented to us with ACS

Case Report

Discussion

Conclusion