BACKGROUND Atherosclerosis represents the main cause of myocardial infarction(MI);other causes such as coronary embolism,vasospasm,coronary-dissection or drug use are much rarely encountered,but should be considered i...BACKGROUND Atherosclerosis represents the main cause of myocardial infarction(MI);other causes such as coronary embolism,vasospasm,coronary-dissection or drug use are much rarely encountered,but should be considered in less common clinical scenarios.In young individuals without cardiovascular risk factors,the identification of the cause of MI can sometimes be found in the medical history and previous treatments undertaken.CASE SUMMARY We present the case of a 34-year-old man presenting acute inferior ST-elevation MI without classic cardiac risk factors.Seven years ago,he suffered from orchidopexy for bilateral cryptorchidism,and was recently diagnosed with right testicular seminoma for which he had to undergo surgical resection and chemotherapy with bleomycin,etoposide and cisplatin.Shortly after the first chemotherapy treatment,namely on day five,he suffered an acute MI.Angiography revealed a mild stenotic lesion at the level of the right coronary artery with suprajacent thrombus and vasospasm,with no other significant lesions on the other coronary arteries.A conservative treatment was decided upon by the cardiac team,including dual antiplatelets therapy and anticoagulants with good further evolution.The patient continued the chemotherapy treatment according to the initial plan without other cardiovascular events.CONCLUSION In young individuals with no cardiovascular risk factors undergoing aggressive chemotherapy,an acute MI can be caused by vascular toxicity of several anticancer drugs.展开更多
Spontaneous coronary artery dissection(SCAD)is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic,non-traumatic separation of the coronary artery wall.The most common profile is a m...Spontaneous coronary artery dissection(SCAD)is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic,non-traumatic separation of the coronary artery wall.The most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk factors.SCAD is frequently linked with predisposing factors,such as postpartum,fibromuscular dysplasia or other vasculopathies,connective tissue disease and hormonal therapy,and it is often triggered by intense physical or emotional stress,sympathomimetic drugs,childbirth and activities increasing shear stress of the coronary artery walls.Patients with SCAD usually present at the emergency department with chest discomfort,chest pain,and rapid heartbeat or fluttery.During the last decades,the most common problem of SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis.However,modern imaging techniques such as optical coherence tomography,intravascular ultrasound,coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease.Treatment of SCAD remains controversial,especially during the last years,where invasive techniques are being used more often and in more emergent cardiac syndromes.Although conservative treatment combining aspirin and betablocker remains the recommended strategy in most cases,revascularization could also be suggested as a method of treatment in specific indications,but with a higher risk of complications.The prognosis of SCAD is usually good and long-term mortality seems to be low in these patients.Follow-up should be performed on a regular basis.展开更多
基金Executive Agency for Higher Education,Research,Development and Innovation Funding,No.PN-III-P2-2.1-PED-2019-2434.
文摘BACKGROUND Atherosclerosis represents the main cause of myocardial infarction(MI);other causes such as coronary embolism,vasospasm,coronary-dissection or drug use are much rarely encountered,but should be considered in less common clinical scenarios.In young individuals without cardiovascular risk factors,the identification of the cause of MI can sometimes be found in the medical history and previous treatments undertaken.CASE SUMMARY We present the case of a 34-year-old man presenting acute inferior ST-elevation MI without classic cardiac risk factors.Seven years ago,he suffered from orchidopexy for bilateral cryptorchidism,and was recently diagnosed with right testicular seminoma for which he had to undergo surgical resection and chemotherapy with bleomycin,etoposide and cisplatin.Shortly after the first chemotherapy treatment,namely on day five,he suffered an acute MI.Angiography revealed a mild stenotic lesion at the level of the right coronary artery with suprajacent thrombus and vasospasm,with no other significant lesions on the other coronary arteries.A conservative treatment was decided upon by the cardiac team,including dual antiplatelets therapy and anticoagulants with good further evolution.The patient continued the chemotherapy treatment according to the initial plan without other cardiovascular events.CONCLUSION In young individuals with no cardiovascular risk factors undergoing aggressive chemotherapy,an acute MI can be caused by vascular toxicity of several anticancer drugs.
文摘Spontaneous coronary artery dissection(SCAD)is a rare non-atherosclerotic cause of acute coronary syndromes defined as non-iatrogenic,non-traumatic separation of the coronary artery wall.The most common profile is a middle-aged woman between 44 and 53 years with few cardiovascular risk factors.SCAD is frequently linked with predisposing factors,such as postpartum,fibromuscular dysplasia or other vasculopathies,connective tissue disease and hormonal therapy,and it is often triggered by intense physical or emotional stress,sympathomimetic drugs,childbirth and activities increasing shear stress of the coronary artery walls.Patients with SCAD usually present at the emergency department with chest discomfort,chest pain,and rapid heartbeat or fluttery.During the last decades,the most common problem of SCAD was the lack of awareness about this condition which has led to significant underdiagnosis and misdiagnosis.However,modern imaging techniques such as optical coherence tomography,intravascular ultrasound,coronary angiography or magnetic resonance imaging have contributed to the early diagnosis of the disease.Treatment of SCAD remains controversial,especially during the last years,where invasive techniques are being used more often and in more emergent cardiac syndromes.Although conservative treatment combining aspirin and betablocker remains the recommended strategy in most cases,revascularization could also be suggested as a method of treatment in specific indications,but with a higher risk of complications.The prognosis of SCAD is usually good and long-term mortality seems to be low in these patients.Follow-up should be performed on a regular basis.
