Infarction In Young Patients Research Articles

PEDUNCULATED AORTIC ROOT THROMBUS CAUSING RECURRENT MYOCARDIAL INFARCTIONS

Aortic thrombosis is a rare cause of acute myocardial infarction in young patients. A 56-year-old man with 20-pack-year smoking history and hypertension presented with acute onset substernal chest pain and ST-segment elevation in inferolateral leads. Coronary angiogram revealed an acute thrombotic

Effect of factor XIII levels and polymorphisms on the risk of myocardial infarction in young patients

Factor XIII (FXIII) stabilizes and protects the fibrin network. Its role in myocardial infarction (MI) is still to be clarified. To evaluate the association of FXIII levels with MI in young patients and to investigate how the FXIII-A p.Val34Leu, FXIII-B p.His95Arg, and IVS11, c.1952 + 144 C>G (Intron K) polymorphisms influence FXIII levels and MI risk. Patients with ST elevation MI below 40years of age (MI, n = 119), age-matched clinical controls (CC, n = 101) without MI and coronary artery disease, and healthy controls (HC, n = 120) were investigated for FXIII activity, FXIII-A2B2, FXIII-B concentrations and for the polymorphisms. FXIII activity and FXIII-A2B2 antigen were significantly elevated in MI. FXIII activity and antigen were significantly elevated in Arg95, while decreased in Intron K "G" carriers. Smoking had an independent increasing effect on FXIII activity and FXIII-A2B2 antigen. Intron K C>G polymorphism significantly decreased the risk of MI in patients with elevated fibrinogen. Among the investigated factors Intron K C>G polymorphism and smoking have the most powerful effect on FXIII levels and on the risk of MI in the young. The effect of smoking on coronary thrombus formation may partially be attributed to its FXIII increasing effect.

Parameters of platelet indices in young patients with ST elevation myocardial infarction. Commentary to the article: "Platelet distribution width and plateletcrit: novel biomarkers of ST elevation myocardial infarction in young patients".

Parameters of platelet indices in young patients with ST elevation myocardial infarction. Commentary to the article: "Platelet distribution width and plateletcrit: novel biomarkers of ST elevation myocardial infarction in young patients".

Response to the letter concerning the article: "Platelet distribution width and plateletcrit: novel biomarkers of ST elevation myocardial infarction in young patients".

Response to the letter concerning the article: "Platelet distribution width and plateletcrit: novel biomarkers of ST elevation myocardial infarction in young patients".

Isotretinoin-associated Possible Kounis Syndrome; Case Report and Other Cardiovascular Side Effects Review of the Literature

Isotretinoin is widely used in the treatment of acne vulgaris and other dermatological diseases. Numerous side effects have been reported in the literature. A myocardial bridge occurs when segments of the coronary artery create an intramyocardial tunnel. Atherosclerotic plaque formation frequently occurs in the segment proximal to a myocardial bridge. Coronary thrombus formation, which is often the cause of myocardial infarction in young patients, can be triggered by many factors. Kounis syndrome is described as acute coronary syndromes associated with allergic or hypersensitivity reactions. This article is a description of the case of a patient predisposed to the development of a thrombus by a myocardial bridge who was successfully treated for coronary thrombosis and which may represent a case of Kounis syndrome associated with isotretinoin use presented in the context of the relevant literature.

Platelet distribution width and plateletcrit: novel biomarkers of ST elevation myocardial infarction in young patients.

Platelets play a central role in myocardial infarction, and platelet activity can be evaluated with platelet indices, including platelet distribution width (PDW) and plateletcrit (PCT). These indices have been demonstrated as markers of prothrombotic state in cardiovascular diseases. Therefore, we aimed to investigate, the usefulness of these biomarkers in ST-elevation myocardial infarction (STEMI) in young patients. This cross-sectional study consisted of 565 subjects who were classified into three groups: group 1 (168 young patients with STEMI), group 2 (173 non-young patients with STEMI), and group 3 (224 age-matched controls with angiographically normal coronary arteries). Male patients aged under 45 years and female patients aged under 55 years were defined as young STEMI. In group 1, PDW and PCT (17.2 ± 0.67, 0.249 ± 0.05, respectively) were significantly higher than the other groups (group 2, 16.4 ± 0.56, 0.231 ± 0.04; group 3, 15.1 ± 0.63, 0.227 ± 0.04). PDW and PCT had moderate negative correlation (r = -0.305, r = -0.330, respectively) with age and moderate positive correlation with peak creatine kinase MB (r = 0.259, r = 0.320, respectively). At multivariate analysis, adjusted for other factors, 1 fL increase in PDW levels was 13.5% more likely to be associated with young STEMI, and similarly, a 1% increase in PCT levels was 18.9% more likely associated with young STEMI. Platelet distribution width and plateletcrit levels seem to be independent markers of STEMI in young patients and may reflect prothrombotic state in this specific population.

Cortical lateralization and cardiac autonomic control. Insights from insular stroke and epilepsy

Autonomic nervous system dysfunction is a common complication of stroke. Human studies and experimental data showed a hemispheric lateralization of autonomic activity concerning the forebrain and particularly the insular cortex. Insular cortex involvement is associated with more pronounced autonomic imbalance leading to life threatening arrhythmias and sudden death. We present two case reports of insular infarction in young patients without any cardiac comorbidity, illustrating a specific lateralized function of insula and its influence on the sympatho-vagal balance that implied differentiated therapeutic management after stroke. The right insular stroke was associated to sympathetic activation and left insular stroke was associated to parasympathetic predominance. The same lateralization of autonomic function with opposite effects on sympatho-vagal balance was also reported in two insular epilepsy cases, illustrating the fact that, beyond the controlling network, the cortical modulation of the autonomic nervous system is asymmetric. Identifying high risk patients prone to develop neurogenic cardiac complications, by better understanding of dysautonomia pathophysiology and consequent implementation of prophylactic and therapeutic interventions may significantly reduce mortality rate in stroke and epilepsy.

Clinical profile of acute myocardial infarction in young patients

BACKGROUND: Coronary artery disease is a devastating disease & when the afflicted individual is under the age of 40, the tragic consequences for family, friends, and occupation are particularly catastrophic and unexpected. The purpose of the present study was to assess the risk factors & angiographic profile of very young patients (aged ≤ 40 years) with first acute myocardial infarction (AMI). METHODS: A cross-sectional study was conducted involving 40 young (≤ 40 years) patients with clinical diagnosis of AMI. They were studied for risk factors, clinical characteristics, and angiographic results. Coronary angiography was done in all patients RESULTS: The commonest age group was between 36-40 years (47%); 90% were male and 10% were females. The major risk factor was smoking (57.5%), followed by dyslipidaemia (55%), & hypertension (42.5%). The most common anatomical location for the MI was the anterior wall (62.5%). Most patients had single vessel disease. Left anterior descending was the commonest vessel (57.5%) involved followed by left circumflex artery. CONCLUSION: AMI in very young almost exclusively occurs in male and smoking was the most common risk factor. Acute anterior MI owing to occluded left anterior descending artery was more frequent.

Management of ST-elevation myocardial infarction in young patients by limiting implantation of durable intracoronary devices and guided by optical frequency domain imaging: “proof of concept” study

The aim of this study was to demonstrate the feasibility and safety of ST-elevation myocardial infarction (STEMI) management in young patients by limiting implantation of durable intracoronary devices (using a bioresorbable stent or medical treatment alone). Patients <50 years old admitted for STEMI with single-vessel disease received a two-stage management strategy. During a second coronary angiography performed between day 2 and day 7, optical frequency domain imaging (OFDI) guided the decision on therapeutic management, i.e., i) in the case of a stenosis greater than 70% or plaque prolapse, implantation of a BVS; or ii) in the other cases, continuation of medical management alone without stenting. All patients underwent systematic angiographic control with OFDI imaging at six months. Among the 653 patients admitted for STEMI, 124 patients were under 50 years old and 45 patients were included. Early management was performed on average at day 3.9 (day 2 - day 7). Thirty-four (34) patients received BVS implantation and 11 were treated medically. Only one major adverse cardiac event (MACE) had occurred at six months. In a selected younger population, the management of STEMI guided by OFDI and based on the concept of limiting implantation of durable intracoronary devices appears to be a feasible and safe therapeutic option.

The effect of vertebral artery hypoplasia in posterior circulation infarction in young patients

Purpose Vertebral artery hypoplasia (VAH) is prevalent in the asymptomatic population and contributes to posterior circulation ischaemic events. The aims of this study were to determine whether VAH is an independent risk factor for posterior circulation infarction (PCI) stroke in young patients and to evaluate its impact on the clinical prognosis of PCI stroke in young patients. Materials and Methods The medical records of 235 young stroke patients were reviewed retrospectively. All patients underwent digital subtraction angiography (DSA). VAH was defined by a diameter of <2 mm or the absence of the lateral vertebral artery on DSA. Logistic regression analyses were performed to elucidate the independent factors associated with PCI stroke in young patients. Then, an independent two-sample t-test was performed to evaluate the clinical effect of VAH. Results Our study included 235 young patients who experienced acute ischaemic stroke, 64 of whom were diagnosed with PCI stroke and 38 of whom (16.2%) were found to have VAH. The multivariate logistic regression analysis indicated that gender and VAH were independent risk factors for PCI stroke in young patients. The independent two-sample t-test showed that among the young patients who experienced PCI stroke, the National Institute of Health Stroke Scale score was not significantly different between the patients with and without VAH. Conclusions Our study showed that VAH increases the risk of PCI stroke in young patients. However, the influence of VAH on clinical outcomes in young patients following PCI stroke is minor.

Unusual Etiology of Acute Myocardial Infarction – Factor V Leiden Mutation

The genetic defect of coagulation factor V known as factor V Leiden produces a resistance to degradation of factor V by activated protein C (APC) and that will increase the risk of venous thromboembolism. The data on arterial thrombosis and acute myocardial infarction associated with APC resistance are still not clearly defined. We report a case of acute myocardial infarction in young patient with no cardiovascular risk factors and the etiology of the myocardial infarction was defined as acute arterial thrombosis associated with factor V Leiden defect, without any significant coronary lesions. Normal 0 false false false EN-US X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"جدول عادي"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

TCTAP A-113 Clinical Characteristics of Acute Myocardial Infarction in Young Patients in Tangshan

TCTAP A-113 Clinical Characteristics of Acute Myocardial Infarction in Young Patients in Tangshan

A study of acute ST elevation myocardial infarction in young patients from government teaching hospital

Context: Myocardial infarction (MI) is being recognized in a younger age group in recent years. MI in the young adult may differ from that in the elderly by virtue of its greater incidence of risk factors and atherosclerotic etiology, the heavy preponderance of male patients. Aims: The aim of this study was to study clinical profile, risk factors, complications, infarct type, management, and outcome in patients 45 years or younger (young) admitted with acute ST elevation MI at a Government teaching hospital in Gandhinagar, Gujarat. Subjects and Methods: This is a retrospective study of all new young patients managed for acute ST elevation MI in ICCU of GMERS Medical College and Hospital, Gandhinagar, Gujarat from January 1, 2012 to December 31, 2013. Data were analyzed with SPSS version 21 software. Results: The mean age of 40.95 years with (89%) males and, (11%) females and male to female ratio was 8.1:1. Most patients (58.9%) were from 41 to 45 years age. The most common clinical presentation was chest pain and sweating (97.3% vs. 11%). Most patients (65.8%) arrived in hospital within 6 h from the onset of symptoms. The most common area of infarction was anterior wall and inferior (61.3% vs. 22.7%). The most common risk factor was smoking (40.7%) followed by hypertension (20.3%) and dyslipidemia (15.3%). The most common complication was arrhythmias (24.65%) followed by recurrent ischemia (12.3%). Most (78.7%) received thrombolysis. In hospital, death was 9.3%. Conclusion: In young acute ST elevation myocardial infarction, smoking is the most important risk factor. These patients have better outcome and prognosis.

Trends in Acute Myocardial Infarction in Young Patients and Differences by Sex and Race, 2001 to 2010: Gupta A, Wang Y, Spertus JA, et al. J Am Coll Cardiol 2014;64:337−45.

Trends in Acute Myocardial Infarction in Young Patients and Differences by Sex and Race, 2001 to 2010: Gupta A, Wang Y, Spertus JA, et al. J Am Coll Cardiol 2014;64:337−45.

Analysis of risk factors of ST-segment elevation myocardial infarction in young patients.

BackgroundAcute myocardial infarction (AMI) is often present in old populations and rare in young people. Its incidence significantly increased recent years. The mechanism and disease course of AMI in young people are probably different from that in old population. The aim of this study was to analyze clinical risk factors of STEMI in young patients.MethodsData was collected from consecutive patients ≤ 44 years of age (young; n = 86) and 60–74 years of age (old; n = 65) diagnosed with STEMI, and 79 young age-matched patients without coronary artery disease (CAD), hospitalized between January 2009 and June 2013.ResultsThe young STEMI group had a significantly higher proportion of males (88.37 vs. 53.16%; P < 0.01), smokers (82.56 vs. 49.37%; P < 0.01) and patients with a family history of early CAD (54.65 vs. 32.91%; P < 0.05) than age-matched controls. Young STEMI patients also had significantly higher levels of fasting blood sugar (6.39 vs. 5.25 mmol/L; P < 0.001), glycated hemoglobin (HbA1c) (6.26 vs. 5.45%; P < 0.05), total cholesterol (5.14 vs. 4.65 mmol/L, P < 0.05), and fibrinogen (Fib) (3.39 vs. 2.87; P < 0.01). Compared with the old STEMI group, young STEMI patients had significantly higher proportions of males (88.37 vs. 63.08%; P < 0.01) smokers (82.56 vs. 41.54%; P < 0.01), and those with a family history of early CAD (54.65 vs. 18.46%; P < 0.01). Young STEMI patients also lower Fib (3.39 vs. 3.88 g/L; P < 0.01), less frequent occurrence of angina pectoris before STEMI (13.95 vs. 29.23%; P < 0.05) compared with the old STEMI group. Logistic regression analysis indicated that male sex (OR = 5.891), smoking (OR = 3.500), family history of early CAD (OR = 3.194), Fib (OR = 2.414) and HbA1c (OR = 1.515) are associated with STEMI in young patients.ConclusionIn addition to previously recognized risk factors (male sex, smoking and family history of early CAD), Fib and HbA1c are associated with STEMI in individuals ≤ 44 years of age without antecedent angina pectoris.

Relationship between levels of homocysteine and serum uric acid and stability of carotid atherosclerotic plaque in young patients with cerebral infarction

Objective To investigate the relationship between levels of homocysteine （ Hcy ） and serum uric acid（ UA） and stability of carotid atherosclerotic plaque in young patients with cerebral infarction .Methods 150 cases of cerebral infarction in young patients carried the carotid ultrasonography were divided into the non -plaque group （ n=37）,stable plaque group（n=52） and unstable plaque group（n=61） according to the results.The levels of Hcy and UA in the three groups of patients were detected and analyzed statistically .Results The stable plaque group′s Hcy and UA levels were （15.92 ±2.52）μmol/L and （294.85 ±25.52）μmol/L,which were significantly higher than those of the non-plaque group（t=7.33,6.89,all P〈0.05）;The unstable plaque group′s Hcy and UA levels were （23.17 ±3.82 ）μmol/L and （ 388.57 ±26.61 ）μmol/L, which were significantly higher than those of the the non-plaque group and stable plaque group（t=9.82,10.02,6.90,7.12,all P〈0.05）.Conclusion There is a close correlation between the stability of carotid artery plaque and the levels of Hcy and UA . Key words: Brain infarction; Cysteine; Uric acid; Atherosclerosis carotid

Trends in Acute Myocardial Infarction in Young Patients and Differences by Sex and Race, 2001 to 2010

BackgroundVarious national campaigns launched in recent years have focused on young women with acute myocardial infarctions (AMIs). Contemporary longitudinal data about sex differences in clinical characteristics, hospitalization rates, length of stay (LOS), and mortality have not been examined. ObjectivesThis study sought to determine sex differences in clinical characteristics, hospitalization rates, LOS, and in-hospital mortality by age group and race among young patients with AMIs using a large national dataset of U.S. hospital discharges. MethodsUsing the National Inpatient Sample, clinical characteristics, AMI hospitalization rates, LOS, and in-hospital mortality were compared for patients with AMI across ages 30 to 54 years, dividing them into 5-year subgroups from 2001 to 2010, using survey data analysis techniques. ResultsA total of 230,684 hospitalizations were identified with principal discharge diagnoses of AMI in 30- to 54-year-old patients from Nationwide Inpatient Sample data, representing an estimated 1,129,949 hospitalizations in the United States from 2001 to 2010. No statistically significant declines in AMI hospitalization rates were observed in the age groups <55 years or stratified by sex. Prevalence of comorbidities was higher in women and increased among both sexes through the study period. Women had longer LOS and higher in-hospital mortality than men across all age groups. However, observed in-hospital mortality declined significantly for women from 2001 to 2010 (from 3.3% to 2.3%, relative change 30.5%; p for trend < 0.0001) but not for men (from 2% to 1.8%, relative change 8.6%; p for trend = 0.60). ConclusionsAMI hospitalization rates for young people have not declined over the past decade. Young women with AMIs have more comorbidity, longer LOS, and higher in-hospital mortality than young men, although their mortality rates are decreasing.

Aortic Thrombosis, a Rare Cause of Acute Myocardial Infarction in Young Patients

Mujer de 40 anos sin factores de riesgo cardiovascular que consulto por dolor toracico. El electrocardiograma mostro elevacion del segmento ST en derivaciones anteriores, y se realizo coronariografia urgente, que evidencio una imagen compatible con trombo oclusivo en el tronco comun izquierdo. Tras pasar una guia, desaparecio la oclusion y se restablecio el flujo en todo el arbol coronario; en la ecografia intracoronaria no se objetivo trombo ni diseccion coronaria. Se traslado a la paciente a nuestro centro por infarto agudo de miocardio anterolateral. A su llegada presentaba recidiva de dolor precordial, nueva elevacion del segmento ST y shock cardiogenico; se realizo nueva coronariografia, que mostro oclusion completa del tronco comun izquierdo por masa compatible con trombo. Con soporte inotropico y contrapulsacion aortica, se implanto stent en el tronco comun izquierdo, con lo que se restauro el flujo coronario (figura 1). La ecocardiografia transtoracica mostro disfuncion sistolica biventricular grave y una masa en la raiz aortica. Mediante ecocardiografia transesofagica bidimensional y tridimensional (figura 2) se confirmo la presencia de una masa trombotica de 30 mm anclada a nivel del ostium y stent del tronco comun izquierdo (flecha) y progresando hacia la valvula aortica. Finalmente hubo que implantar asistencia ventricular como puente al trasplante cardiaco; la masa desaparecio, probablemente en relacion con el tratamiento anticoagulante. La presencia de trombos en la aorta ascendente es una causa rara de infarto agudo de miocardio. El diagnostico debe realizarse con ecocardiografia transesofagica, ya que permite caracterizar la masa y realizar el diagnostico diferencial con otras masas. Su tratamiento es controvertido, y se recomienda anticoagulacion y trombectomia para los casos en que la anticoagulacion fracase. Figura 2. Figura 1.

Renal Infarction in Antiphospholipid Antibody-negative Pediatric Systemic Lupus Erythematosus Patient

Systemic lupus erythematosus (SLE) is an autoimmune disease affecting multiple organ systems, and is characterized by the deposition of immune complexes and a large array of autoantibodies. Thrombosis is a relatively frequent and serious complication of SLE; however, renal infarction in young patients with antiphospholipid antibody-negative lupus has rarely been reported, and no pediatric case has been reported in Korea. A 12-year-old female patient was presented to our hospital with a 3-day history of nausea, vomiting, and right flank pain. She was diagnosed with SLE and lupus nephritis two years ago and was treated with corticosteroids and hydroxychloroquine, azathioprine. Abdominal computed tomography (CT) showed renal infarction in the upper pole of the right kidney. Subcutaneous low molecular weight heparin was started, and warfarin was also started simultaneously and continued for 3 months. After 3 months, only minimal atrophic changes were seen on the abdominal CT. She is doing well by maintaining oral anticoagulant therapy and is being followed up regularly through outpatient clinic visits.

Young coronary artery disease in patients undergoing percutaneous coronary intervention

BACKGROUND AND OBJECTIVESUnderstanding the nature and pattern of young coronary artery disease (CAD) is important due to the tremendous impact on these patients’ socio-economic and physical aspect. Data on young CAD in the southeast Asian region is rather patchy and limited. Hence we utilized our National Cardiovascular Disease Database (NCVD)—Percutaneous Coronary Intervention (PCI) Registry to analyze young patients who underwent PCI in the year 2007 to 2009.DESIGN AND SETTINGSThis is a retrospective study of all patients who had undergone coronary angioplasty from 2007 to 2009 in 11 hospitals across Malaysia.METHODSData were obtained from the NCVD—PCI Registry, 2007 to 2009. Patients were categorized into 2 groups—young and old, where young was defined as less than 45 years for men and less than 55 years for women and old was defined as more than or equals to 45 years for men and more than or equals to 55 years for women. Patients’ baseline characteristics, risk factor profile, extent of coronary disease and outcome on discharge, and 30-day and 1-year follow-up were compared between the 2 groups.RESULTSWe analyzed 10 268 patients, and the prevalence of young CAD was 16% (1595 patients). There was a significantly low prevalence of Chinese patients compared to other major ethnic groups. Active smoking (30.2% vs 17.7%) and obesity (20.9% vs 17.3%) were the 2 risk factors more associated with young CAD. There is a preponderance toward single vessel disease in the young CAD group, and they had a favorable clinical outcome in terms of all-cause mortality at discharge (RR 0.49 [CI 0.26–0.94]) and 1-year follow-up (RR 0.47 [CI 0.19–1.15]).CONCLUSIONWe observed distinctive features of young CAD that would serve as a framework in the primary and secondary prevention of the early onset CAD.