Case Of Acute Myocardial Infarction Research Articles

Efficacy and safety analysis of first-line tirelizumab combined with paclitaxel-containing chemotherapy regimen in 30 cases of real-world advanced gastric cancer in China.

e14643 Background: According to the latest global cancer statistics, gastric cancer is the 6th most common tumor with the highest incidence rate and the 5th highest mortality rate in the world. The primary treatment for advanced gastric cancer is still based on chemotherapy, and the median overall survival (OS) of patients treated with conventional chemotherapy is only 12 months. Recently, the rapid rise of immunotherapy has also brought new hope to gastric cancer patients. Many trials related to chemotherapy combined with immunotherapy for advanced gastric cancer are currently underway, which has been a hot research topic in recent years and has had auspicious positive results, such as the KEYNOTE-059 and CHECKMATE649 study. To reduce the burden of disease, the accessibility of innovative drugs has been significantly improved, providing more new clinical treatment ideas and options for Chinese patients with advanced gastric cancer. Methods: The study enrolled advanced gastric cancer (HER-2 negative) was treated with immune combination paclitaxel for first-line treatment, as follows: receiving intravenous albumin-conjugated paclitaxel (260 mg/m2) every 3 weeks; in combination with Tirelizumab (200 mg every three weeks), and after 4-6 cycles of treatment, Tirelizumab was maintained until disease progression or intolerance. The primary study endpoints were progression-free survival (PFS) and overall survival (OS), and the secondary endpoints were objective remission rate (ORR) and safety. Results: From July 2020 to August 2023, 30 patients received first-line immunization and paclitaxel-containing chemotherapy regimens at our center. The objective remission rate (ORR) was 40.9%, and the disease control rate (DCR) was 77.3%. The incidence of treatment-related grade 1-2 adverse reactions was: vomiting in 5 cases (16.7%), loss of appetite in 22 cases (73.3%), diarrhea in 10 cases (33.3%), transaminase elevation in 5 cases (16.7%), numbness of the hands and feet in 25 cases (83.3%), leukopenia in 7 cases (23.3%), and hemoglobin reduction in 16 cases (53.3%). hyperbilirubinemia in 2 cases (6.7%). Grade 3-4 adverse events and their incidence were: vomiting in 4 cases (13.3%), loss of appetite in 4 cases (13.3%), diarrhea in 1 case (3.3%), transaminase elevation in 2 cases (6.7%), leukopenia in 3 cases (10.0%), and hemoglobin reduction in 2 cases (6.7%). There were 3 cases of immunosuppressant-related adverse reactions (1 case of immunosuppressant-associated thyroiditis, 1 case of immunosuppressant-associated acute myocardial infarction, Conclusions: The first-line treatment of advanced gastric cancer with immune checkpoint inhibitors combined with paclitaxel-containing chemotherapy has a high rate of disease control, prolongs overall survival, has more clinical adverse reactions, is favored by grade 1-2 adverse reactions, and has a high degree of safety, and provides a new clinical idea for the first-line treatment of patients with advanced gastric cancer. Clinical trial information: KY2022-189-02.

AN ACUTE MYOCARDIAL INFARCTION IN A VERY YOUNG MAN DUE TO HYPERHOMOCYSTEINEMIA

Abstract Introduction A young 17–year–old boy smoker and obese was admitted to our cardiology unit for continuous oppressive chest pain radiating to the left arm that had arisen three days earlier. In the emergency room, he had performed blood tests with evidence of an increased troponin and an electrocardiogram that showed mild ST–elevation in inferior leads with ST depression in aVL. We performed an urgent transthoracic echocardiography examination that was unremarkable Investigation Once diagnosed with acute ST–segment elevation myocardial infarction, the patient underwent emergency coronary angiography. Coronary angiography highlighted an intermediate stenosis of the first branch diagonal to the proximal tract and a possible occlusion of the periapical branch of the anterior descending artery. It was decided not to perform PTCA as we could not exclude a distal coronary dissection and considering the vessel was of small caliber. We decided to complete the diagnostic process by performing a cardiac MRI showing edema in the apex and distal inferior wall and transmural gadolinium enhancement at the level of the septum and inferior wall of the distal section. In the context of the damaged wall a focal area of hypointensity to be referred to the "no–reflow" phenomenon Management The patient was treated with DAPT, low molecular weight heparin and high dose statin. A few hours after the coronary angiography the patient stopped having chest pain and remained asymptomatic for the rest of the hospital stay. We performed complete blood tests including with evidence of hyperhomocysteinemia. The lipid panel was normal. Hematological consultation recommended folate and Vitamine B12 treatment. After 12 months the patient is asymptomatic, has stopped smoking and continues to take DAPT. He repeated the echocardiogram which showed no alterations. Genetic testing was performed after hospital discharge and was positive for Methylenetetrahydrofolate reductase (MTHFR) homozygous mutation Conclusion Our clinical case shows a rare case of acute myocardial infarction in a very young person. Diagnosis and treatment were complicated by the extreme distality of the occlusion and the few modifiable risk factors identified (smoker, obesity and hyperhomocysteinemia). Hyperhomocysteinemia is an often underestimated cardiovascular risk factor associated with a high risk of cardiovascular events and multivessel coronary disease that should be sought in all young patients with AMI.

A Case of acute Myocardial Infarction in a Patient with Essential Thrombocythaemia Treated with Anagrelide.

The dual role of anagrelide: although anagrelide is effective in lowering platelet levels in essential thrombocythaemia, it can increase platelet activation, raising thrombotic risk. Clinicians need to monitor patients closely for thrombotic events.Balancing efficacy and side effects: the risk of severe side effects such as myocardial infarction, as seen in this case report, necessitates a balanced approach in using anagrelide, weighing its benefits against potential risks.

Ventricular septal defect complicating anterior acute myocardial infarction : A Case of transcatheter closure

IntroductionPost-infarction ventricular septal defect (PIVSD) is one of the most serious mechanical complications of acute myocardial infarction (AMI). Over the last decade, percutaneous closure is increasingly undertaken, with results similar to cardiac surgery. We present a case of ST-elevated anterior AMI, complicated by apical PIVSD successfully treated with transcatheter closure. Case ReportAn 83-year-old man was hospitalized for chest pain occurred 18 hours before, during the night time. He was an active smoker. Clinical examination revealed normal heart sounds and pulmonary bibasilar crackles. ST-segment elevation with deep T waves inversion in anterior leads were detected on the electrocardiogram. A mildly-reduced ejection fraction (40%) was found by transthoracic echocardiogram. The patient underwent emergency coronary angiography, which revealed a subocclusive stenosis of the mid left anterior descending artery with a TIMI 2 flow, treated by balloon angioplasty and drug-eluting stent. Four days after revascularization, the patient developed an acute deterioration with signs of decompensated heart failure and a new holosystolic murmur with large irradiation. Inotropic agents’ administration was required to maintain a precarious hemodynamic condition. A bedside Echo revealed an apical VSD, measuring 15 × 10 mm, with left-to-right shunting, and pulmonary hypertension. The patient was scheduled for transcatheter PIVSD closure. The procedure was performed under fluoroscopic guide. Two vascular access sites were placed, femoral arterial and right internal jugular vein. Through the right internal jugular vein, a 24-mm Amplatzer atrial septal occluder on a 9 French Amplatzer TREVISIO™ intravascular delivery system was advanced via right ventricle into the PIVSD. Contrast fluoroscopy was used to assess apposition and the degree of shunt reduction before release. Echocardiographic evaluation performed 48 hours later confirmed a correct apposition of the device with insignificant residual shunt. At 6 months follow-up, he was asymptomatic, with unchanged prosthetic findings. ConclusionPercutaneous closure has been emerged as a valid cost-effective alternative to surgery and should be advised. However, debate remains on the optimal preprocedural optimization, timing of repair and modality of treatment.

ACUTE MYOCARDIAL INFARCTION IN A PUERPERA: A CASE REPORT

We report a lethal case of acute myocardial infarction in a puerpera. Cardiovascular diseases rank as the leading causes of mortality during pregnancy and the postpartum period, with myocardial infarction (MI) being a rare yet frequently fatal occurrence. Research indicates that MI typically manifests between 6 to 12 weeks postpartum, though instances may also occur at later stages. The reported case is interesting in terms of the mismatch between the timing of clinical symptoms of acute coronary syndrome (less than 24 hours) in the puerpera and alterations in myocardial infarction (2-3 days), which was diagnosed morphologically. Therefore, we searched for possible causes that led to the clinical and morphological changes described above. At first glance, the main cause of myocardial infarction development is coronary artery dissection with the formation of hematoma in the wall of the blood vessel, which narrows its lumen and leads to necrosis of the heart muscle. A brief analysis of the case has established that ischemic damage to the myocardium preceded the development of spontaneous coronary artery dissection and could be caused by one of the factors or a combination of them: coronary artery spasm caused by ergometrine and anemia due to uterine atony-related postpartum hemorrhage. The formation of intramural hematoma of the vascular wall, which narrowed the lumen of the coronary artery, could be the result of the prescription of antithrombotic therapy, which complicated the health status of the woman and led to death. When providing medical care to puerperas with postpartum hemorrhage, it is necessary to take into account the risk for cardiovascular complications that could develop due to anemia or administration of ergometrine.

Socioeconomic status and access to care in a universal health care system: The case of acute myocardial infarction in Australia

This paper examines the role of socioeconomic status (SES) in affecting access to care and the survival of acute myocardial infarction (AMI) patients in Australia's universal health care system. We jointly model the probabilities of patients being admitted to a catheterisation-capable hospital, receiving invasive coronary angiography (ICA), and surviving 30 days post discharge as a recursive system of probit equations. We further investigate the role of capacity and whether the access gap between SES groups widens when capacity becomes limited.Our study shows that SES plays a significant role in affecting the survival of AMI patients, both directly and indirectly through healthcare access. We find that socioeconomically disadvantaged patients are less likely to gain access to crucial services like catheterisation hospitals and ICA, which indirectly affects their survival probability in addition to the adverse direct impact of SES. While healthcare capacity showed no overall effect on access, its interplay with SES exacerbates the access disparity in situations of limited capacity. Our findings suggest that, to reduce inequality in health outcomes, public health strategy needs to focus not only on enhancing access but also addressing the direct consequences of SES.

Thrombolysis for acute myocardial infarction in early post-renal transplant period: A case report

Cardiovascular disease is a major contributor to morbidity and has become the leading cause of death among renal transplant patients. This paper presents a case of acute myocardial infarction occurring three weeks after a renal transplant. A 45-year-old male recipient experienced acute chest pain, hypotension, and atrial fibrillation, leading to a diagnosis of inferior-posterior wall myocardial infarction. Thrombolysis with Tenectaplase was administered, resulting in the development of a perinephric hematoma six hours later. The patient underwent transfusions and pigtail drainage of the hematoma. Following hematoma resolution, the pigtail catheter was removed, and the patient was started on dual anti-platelets. Upon discharge, the patient exhibited stable renal function. In conclusion, thrombolysis in the early post-transplant period poses significant risks. This case highlights the use of thrombolytic therapy during this period and the successful management of associated complications.

Acute Myocardial Infarction Due to Coronary Artery Embolism During Chemotherapy with mFOLFOX-6 Plus Bevacizumab for Metastatic Colon Cancer: A Case Report.

Bevacizumab, a monoclonal antibody against vascular endothelial growth factor, may be associated with arterial embolisms. We herein report a case of acute myocardial infarction caused by coronary embolism during combination chemotherapy with mFOLFOX-6 and bevacizumab in a patient with metastatic colon cancer. Thromboembolism occurred only in the distal right posterolateral branch without stenotic lesions or plaque rupture in the proximal branch of the right coronary artery. Sole thromboaspiration was successfully performed; the final angiogram demonstrated no stenosis in the right coronary artery. Bevacizumab may be associated with acute coronary syndrome in patients with coronary risk factors, despite no significant coronary narrowing.

Случай острого инфаркта миокарда у пациента трудоспособного возраста с язвенным колитом на фоне позднего начала патогенетической терапии

The article describes a case of acute myocardial infarction with multiple atherosclerotic lesions of the coronary arteries in a working-age patient with ulcerative colitis, against of late initiation of pathogenetic therapy.

A Case of Acute ST-Segment Elevation Myocardial Infarction as an Initial Presentation of Essential Thrombocythemia in a Young Healthy Male

A Case of Acute ST-Segment Elevation Myocardial Infarction as an Initial Presentation of Essential Thrombocythemia in a Young Healthy Male

Trombosis coronaria en paciente con esclerosis múltiple: a propósito de un caso

La enfermedad coronaria es la principal causa de muerte a nivel mundial. Se han descrito factores de riesgo clásicos para desarrollarla, como la hipertensión y la diabetes mellitus; sin embargo, otras entidades como la esclerosis múltiple (EM) pueden aumentar el riesgo de cardiopatía isquémica en muchos pacientes, con una incidencia 24% mayor que en las personas sin EM, la cual puede ser debida a disfunción del sistema nervioso autónomo o a efectos adversos de medicamentos utilizados en esta patología. Describimos un caso de infarto agudo de miocardio en un paciente con EM y revisamos la asociación de estas dos enfermedades.

St-elevation myocardial infarction in a healthy 16-year-old adolescent: a clinical case

Background. Diagnosis of acute myocardial infarction (AMI) in pubertal patients is a diagnostic challenge, as individuals of such a young age usually do not have traditional risk factors for coronary heart disease (CHD) and, as a result, are at increased risk of misdiagnosis.Objective. To describe a clinical case of AMI in a 16-yearold patient against the background of complete well-being.Design and methods. A 16-year-old patient, against the background of complete well-being, developed pressing pains in the chest, which stopped on their own after a few hours. During hospitalization, in addition to an increase in the level of troponin, the results of other laboratory and instrumental studies did not confirm the version of AMI, as a result of which other cardiac and non-cardiac causes of the development of chest pain formed the basis of the diagnostic search. This was the reason for the delayed diagnosis and endovascular treatment of thrombotic occlusion of the right coronary artery, and, as a result, the formation of an area of persistent hypokinesia of the lower parts of the left ventricle. Further search for possible causes of AMI, including the analysis of genetically associated conditions, did not yield results.Results. This publication describes a case of acute inferior myocardial infarction with ST segment elevation and thrombotic occlusion of the right coronary artery in a 16-year-old adolescent and the impact of an irrational diagnostic process on long-term prognosis.Conclusion. The presented clinical case demonstrates the importance of including the diagnosis of AMI in the process of differential diagnosis of acute chest pain, even in adolescent patients.

Case of acute recurrent myocardial infarction in a child

Information on the essential aspects of prevalence, etiology and pathogenesis of coronary heart disease, which is the leading cause of death in the world, is given in this article. It is emphasized that the incidence of ischemic coronary events is the result of a complex sequence of pathogenetic links, which involves the formation of atherosclerotic lesions and destabilization as the primary provoking factor. Purpose - the attraction of the medical community attention to the problem of ischemic heart disease in children. A clinical case of recurrent myocardial infarction in a child who was examined and treated at the MNPE «Ivano-Frankivsk Regional Children’s Clinical Hospital of the Ivano-Frankivsk Regional Council», is described here. The key points of the patient’s complaints, anamnesis of life and this disease are described, the data of the objective condition at the hospitalization and during dynamic observation of the child, which showed the signs of left ventricular overload, coronary blood flow disorder, dilatation of the left heart ventricles, decreased left ventricular contractility. The data of the main indices of laboratory and instrumental methods of research, including X-ray diagnostic methods, performed not only on the basis of the department, but also in the Scientific-Practical Medical Center of Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine (Kyiv). The treatment of this clinical case in the child is described in this article. The data of dynamic observation are given. The discussion and conclusions emphasize the problem of coronary insufficiency in pediatrics, which requires clinical understanding, the choice of the correct diagnostic algorithm and qualified medical care. The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of the child’s parents was obtained for the research conduction. No conflict of interests was declared by the authors.

Acute myocardial infarction and pulmonary embolism in a young serviceman with a mutation of the plasminogen activator inhibitor gene type 1

The clinical case of acute myocardial infarction and pulmonary embolism in a young soldier with the first occurred protracted attack of angina. The survey found the link between these conditions and gene mutation of type 1 plasminogen activator inhibitor that plays a key role in fibrinolysis by inhibiting the formation of plasmin and leading to slowdown in fibrinolysis processes and a longer-term persistence of blood clot. It is proven that homozygous 4G/4G mutation found in the patient results in the development of arterial and venous thrombosis at a young age and is associated with a tendency to relapse. It clearly shows that hereditary thrombophilia is characterized by the absence of obvious provocative factor and single universal diagnostic algorithm; the diagnosis is based on the comprehensive evaluation of laboratory data.

Kounis syndrome: Beware of bee sting!

The Kounis syndrome is described as acute coronary syndrome associated with allergic reaction. It can be triggered by various causes and is associated with significant morbidity and mortality. It is important for physician to recognize this syndrome and its clinical significance as it can be misdiagnosed and the management requires attention to both cardiac and anaphylactic pathophysiology. We reported a case of acute infero-posterior myocardial infarction triggered by bee sting, and discussed its possible underlying mechanism, treatments and its successful outcome.

A Case of Acute Myocardial Infarction due to Simultaneous Occlusion of Two Vessels Caused by Delayed-Onset Heparin-Induced Thrombocytopenia

A Case of Acute Myocardial Infarction due to Simultaneous Occlusion of Two Vessels Caused by Delayed-Onset Heparin-Induced Thrombocytopenia

Socioeconomic Status and Access to Care in a Universal Healthcare System: The Case of Acute Myocardial Infarction in Australia

Socioeconomic Status and Access to Care in a Universal Healthcare System: The Case of Acute Myocardial Infarction in Australia

Случай острого инфаркта миокарда у молодого пациента с впервые выявленным нефротическим синдромом

Thromboembolic complications in nephrotic syndrome (NS) are frequently encountered in the practice of a nephrologist and in many cases determine the course and outcome of diseases. The article presents a clinical case of acute ST-segment elevation myocardial infarction with Q tooth of posterior basal, lateral localization in a 36-year-old patient with a newly diagnosed nephrotic syndrome. In the young patient without a history of cardiovascular risk factors, coronary angiography revealed signs of progressive atherosclerotic stenosis of the coronary arteries, and the cause of MI was thrombotic occlusion of the enveloping branch of the left coronary artery. This clinical case required a more detailed study; the examination revealed a set of factors that led to MI in this young patient.

Acute Myocardial Infarction as a Sequel of Cocaine Abuse

Cocaine is considered the second most frequently used illicit drug and the most frequent cause of drug-related deaths in the world. Worldwide, the majority of cocaine users are younger people between the ages of 16 and 26 years old; and 11% of the general population is thought to have used it at some point in time. Cocaine users primarily administer cocaine orally, intranasally, intravenously, or by smoking it. Cocaine abuse leads to serious complications that involve all body systems, especially the cardiovascular system. In this study, we reported a case of acute myocardial infarction in a young patient without known chronic diseases. Twenty years old male patient presented with acute epigastric pain and repeated vomiting. He has a two-year history of cocaine abuse. All routine investigations were rapidly done; however, the patient collapsed and cardiopulmonary resuscitation (CPR) was performed. Clinical outcome: the patient, unfortunately, died after all trials to save his life and was diagnosed with severe myocardial infarction.

Correction to: A case of acute myocardial infarction caused by a giant thrombus derived from an aneurysm of the sinus of valsalva and a bioprosthetic aortic valve

Correction to: A case of acute myocardial infarction caused by a giant thrombus derived from an aneurysm of the sinus of valsalva and a bioprosthetic aortic valve