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Christofferson RD. Acute Miocardial Infarction. In : Griffin BP, Topol EJ, eds. Manual of cardiovascular
medicine. 3rd ed. Philadelphia: Lippincot Williams & Wilkins, 2009: 1-28.

  
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30.00%  

25.00%
20.00%
60
15.00% Causes of Death **
10.00%
40 Cardiovascular Mortality
5.00% Rate *
20
0.00%
1975 1981
0 1986 1995 2004
CAD Stroke
Lung
Cancer
disease Others

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à wncidence of Mw and symptomatic CAD in
young adult about 3 % of all CAD
(Klein LW, J A m Coll Cardiol 2003, 41: 521)
ACS in Young Adult in
NCVCHK*

2006: 10,1 % (92 among 962)


2007: 10,7% (117 among 1096)
2008: 10,1% (108 among 1065)

rData from Medical Record Unit National Centre of Cardio Vascular


Harapan Kita, 2009
AwM OF PRESENTATwON

à The aim of this case presentation is to


present a case of a myocardial infarction
in young adult.
à To elaborate some risk factors for
myocardial infarction in young adult
   !"

36 years old male Hospital Admission : Jan 14th, 2010À EMG


NCCHK

Chief Complaint:
Shortness of breath since 2 weeks before
admission
HwSTORY OF PRESENT wLLNESS
$% #$ $& # # $#
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)

Ô×  Ô ’  


 
Ԓ×  
 ×  Ô 
 
Ô  × À Therapies:
’   Farsorbid 3x 5 mg
 Aspilet 1x 80 mg
! "# Plavix 1x 75 mg
Sinvastatin1x 20 mg
ÀReferred to NCCHK for CABG
PHYSwCAL EXAMwNATwON
 Patient·s condition : looked moderately ill /CM
 Weight/height : 71 kg/ 163 cm
 BP : 103/67 mmHg
 HR : 94 bpm
 RR : 24/min
 Head : Conjunctiva was not pale and sclera was
not icteric
 Neck : JVP: 5-2 cmH2O
 Cardiac auscultation : normal S1 and S2, no murmur, no gallop
 pulmonary sound : vesicular with no rales, nor wheezing
 Abdomen : No ascites, no liver and spleen
enlargement, normal peristaltic sound.
 Extremities : warm, no oedema
ECG

SR, QRS rate 94 x/i, axis + 900 , normal P wave, PR int 0,14 s, QRS dur 0,06 s, QS with inverted T wave
at V2 ² V6, w, aVL
CHEST X-
X-RAY

CTR 60 %, Normal Aorta segment, Normal pulmonary segment , cardiac waist (-), downward lateral
apex, congestion (-), infiltrat (-)
Laboratory
à Hb 12,5 mg/dl Ô Chloride 105 mmol /l
à leucosit 6530/ul Ô Magnesium 1,8 mmol/l
à Ht 37
Ô total cholesterol 169 mg/dl
à CKMB 10 U/l
à Trop T 0,13 ng/ml Ô Lp(a) 3,6 mg/dl
à Ureum 26 mg/dl Ô [  
  
à BUN 12,15 mg/dl
Ô LDL cholesterol 99
à Creatinin 1,2 mg/dl
à random blood glucose 95 Ô trigliserida 241 mg/dl
mg/dl Ô   
[ 
à sodium 137 mmol/l
 

 
à potassium 4,7m mol/l
à total Calcium 2 m mol/l,  
Ô  .
TTE
Catheterization
DwAGNOSwS
à Heart Failure Fc www ec recent anterior
MCw onset 21 days ec CAD 3 VD
Therapy
à Aspilet 1 x 80 mg
à Plavix 1 x 75 mg
à Fasorbid 3 x 5 mg
à Simvastatin 1 x 20 mg
à Captopril 3 x 6,25 mg
à Laxadine 1 x C1
à Diazepam 1 x 5 mg
à Aldactone 1 x 12,5 mg,
à Concor 1 x 1,25 mg
   #$
à Many differences between young and older patients are
described
à Except classical risk factors leading to ACS other cardiac
predictors are being searched in the group of younger
sick persons.
à wt is worth considering the importance of defects of
coagulation:
o proportions· disorders of tissue factor,
o tissue plasminogen activator
o Leiden factor, protein C
o lipoprotein (a)
o mutations of propter genes (the role of the polymorphism in the
fibrinogen beta-chain gene, prothrombin gene, thrombopoetin gene).

Debska A and Lelonek M, Defects of coagulation and antiphospholipid antibodies in patients up to 40 years
old with acute coronary syndrome, Index Copernicus Journal Abstract, Arc Med Sci 2005; 1 (1): 34 - 36
Novell risk factors as a potential new
screening tools
à hsCRP
à markers of inflammation
o lipoprotein(a)
o homocysteine
à markers of fibrinolytic and hemostatic function
o fibrinogen
o D-dimer
o tissue plasminogen activator (t-PA)
o plasminogen activator inhibitor 1 (PAw-1) antigens

Riedker PM and Libby P. Risk Factor for atherotrombotic Disease. In: Zipes DP, Libby P, Bonow
RO, Braunwald E. Braunwald Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. Philadelphia:
Elsevier Saunders, 2008: 1012 - 023.
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à This patient is man and smoker
à His lipid profile were:
o total Cholesterol 169 mg/dl
o HDL cholesterol 21 mg/dl
o LDL cholesterol 99 mg/dl
o trigliserida 241 mg/dl
o total cholesterol:HDL cholesterol ratio 8,05.
à His Lp(a): 3,6 mg/dl
à hsCRP: 3,1 mg/dl.
The American Heart Association and the
Centers for Disease Control and Prevention
issued guidelines in 2003 for the use of
hsCRP in clinical practice.

hsCRP levels less than 1, 1 to 3, and higher


than 3 mg/liter should be interpreted as
lower, moderate, and higher relative
vascular risk, respectively, when considered
along with traditional markers of risk.
PROVE IT-TIMI 22 clinical trial conducted in
patients with acute coronary syndromes
treated with statin therapy

achieving levels of hsCRP less than 2 mg/liter


was as important for long-term event-free
survival as was achieving levels of LDL
cholesterol less than 70 mg/dl; in fact, the best
long-term outcomes were found in those who
achieved both these goals.
à Relative risks of future myocardial infarction among apparently healthy women according to baseline levels of
lipoprotein(a), homocysteine, interleukin-6, total cholesterol, low-density lipoprotein (LDL) cholesterol, soluble
intercellular adhesion molecule-1 (swCAM-1), serum amyloid A, apolipoprotein B, ratio of total cholesterol to high-density
lipoprotein cholesterol (TC:HDLC), high-sensitivity C-reactive protein (hsCRP), and the combination of hsCRP with the
TC:HDLC. ·  
           
  
RESUME
à A case report of a 35 years old male, came
to emergency
à chief complain: shortness of breath.
à The patient has conventional risk factor such
as smoking and lipid disorder.
à He also had high level of hsCRP as novel risk
factors.
à The patient underwent successful PCw
procedure with 1 drug eluting stent in mid
part of LAD and discharge properly.
Ashen MD, N Eng J Med 2005, 353 : 1253
Zimmerman FH, JACC 1995, 26 : 654 - 61
Zimmerman FH, JACC 1995, 26 : 654 - 61
Zimmerman FH, JACC 1995, 26 : 654
Tsimikas S, et al. J Am Coll Cardiol 2006, 47 : C 20
wnterheart

www.INTERHEART Nine modifiable risk factors predict 90%25 of acute MI.htm


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