PP-206: HYPERHOMOCYSTEINEMIA AND ACUTE ANTERIOR MYOCARDIAL INFARCTION IN A YOUNG WOMAN

Abstract

Objective: Hyperhomocysteinemia arising from impaired methionine metabolism. It is regarded as independent risk factor for ischemic vascular diseases and thrombosis. Homocysteine may impair vascular endothelial cell function. it may also induce oxidation of low-density lipoproteins. its deleterious effect on vascular endothelium, might be associated with an increase in coronary thrombosis during acute myocardial infarction. We report a 19 year old woman with an acute myocardial infarction associated with hyperhomocysteinemia. Methods: A 19-year old woman was admitted to our hospital because of a six hour history of typical chest pain and hospitalized with diagnosis of acute anterior myocardial infarction. His past medical was unremarkable. She was not taking oral contraceptives or any other medication. Family history showed that the patient’s mother had had a deep vein thrombosis and her father was healthy. Initial physical examination revealed blood pressure of 110/70 mmHg, respiratory rate of 27/min, and a pulse rate of 90/min. On cardiac auscultation, heart sounds were soft and 1/6 systolic murmur was heard in the mezocardiac area. The respiratory sounds on auscultation were normal. The electrocardiogram showed marked ST segment elevation in the anterior leads. The patient was submitted to catheterization laboratory for percutaneous coronary intervention. Coronary angiography showed normal right, left main, and left circumflex coronary arteries and total occlusion of the proximal left anterior descending coronary artery (LAD) (Figure 1a). The LAD was successfully revascularized with percutaneous balloon angioplasty (Figure 1b). Results: Coagulability testing showed elevaed homocysteine levels (50 mmol/l). Genetic testing for the methylenetetrahydrofolate reductase C677T gene mutation was positive. She was treated with heparin intravenously followed by warfarin.