1/28. Myocardial infarction in patients with systemic lupus erythematosus with normal findings from coronary arteriography and without coronary vasculitis--case reports.The authors present the cases of two young patients, a man and a woman, who presented with myocardial infarction, in the absence of ischemic heart disease or stenosis of the coronary arteries. The woman was known to have systemic lupus erythematosus (SLE) for the past 3 years (the immunoglobulin m [IgM] anticardiolipins antibodies were positive), without a history of coronary risk factors. Suddenly she presented with acute chest pain on rest that lasted 4 hours and culminated in anterior wall myocardial infarction. She was admitted to the coronary care unit, where no thrombolysis was given. She did not have echocardiographic evidence of Libman-Sacks endocarditis, but myocardial infarction was evident at the electrocardiogram (ECG). The young man had SLE (the IgM anticardiolipins were absent, but he was positive for lupus anticoagulant antibodies), he was hyperlipidemic, was a moderate smoker and moderately obese, and had no history of ischemic heart disease. He suddenly presented with an acute myocardial infarction documented by ECG, enzymes, and gammagraphy. In both patients, coronary angiography findings were normal and myocardial biopsy did not show evidence of arteritis. The relevance of these cases is the rare association of ischemic heart disease in SLE, with normal coronary arteries and without evidence of arteritis or verrucous endocarditis.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/28. Case 4: type 2 diabetes, hypertension, and dyslipidemia.patients at risk for coronary heart disease often have multiple underlying risk factors, including hypertension, type 2 diabetes mellitus, and dyslipidemia. The focus of this month's CME case study is recognition of these often silent and coexisting diseases, and the selection of appropriate therapy that will not adversely affect management of comorbid conditions.- - - - - - - - - - ranking = 0.076923076923077keywords = coronary (Clic here for more details about this article) |
3/28. Management of hypertension and dyslipidaemia in patients presenting with hyperuricaemia: case histories.A number of studies have shown that hyperuricaemia is associated with an increased incidence of coronary heart disease. It has been proposed that the elevated serum uric acid levels are linked to other risk factors, such as hypertension, dyslipidaemia and diabetes. Hyperuricaemia is commonly encountered in patients with essential hypertension and is considered as a risk factor for morbidity and mortality associated with hypertension. In addition, lipid abnormalities (mainly hypertriglyceridaemia) are also found more frequently in hypertensive patients than in normotensives. There is evidence that the angiotensin ii receptor antagonist, losartan, increases urate excretion by reducing reabsorption of urate in the renal proximal tubule. It is also known that fibric acid derivatives (fibrates) have several beneficial actions in addition to their lipid-lowering capacity. fenofibrate administration is associated with a uric acid lowering effect. In this respect, we present two patients with hypertension and dyslipidaemia together with elevated serum uric acid levels. We also discuss (in the format of questions and answers) the pathophysiological mechanisms underlying the association of serum uric acid with cardiovascular disease, and we review the relevant literature to justify an evidence-based decision to choose an antihypetensive agent (losartan) or a lipid-lowering drug (fenofibrate) with an additional hypouricaemic effect.- - - - - - - - - - ranking = 0.076923076923077keywords = coronary (Clic here for more details about this article) |
4/28. Identifying all suspects: case studies.Case presentations are one of the most instructive formats for learning. They allow the healthcare practitioner to identify and discuss patients who are at risk for a disease and then discuss appropriate therapy. Two patients who have dyslipidemia and are at risk for a coronary event are described here, along with treatment goals and options, audience responses, and discussions of appropriate therapy choices. Both patients require aggressive lipid management. One has had an angioplasty with placement of a stent. His case is an example of a patient at risk for a secondary coronary event; we refer to these cases as secondary-prevention patients. The other patient has high blood pressure and type 2 diabetes; her risk for a future coronary event based on Framingham risk data is greater than 20% in 10 years and therefore her risk for a future coronary event is equal to someone with established coronary heart disease (CHD). Her case is an example of what we refer to as a primary-prevention patient at high risk. Several large-scale primary- and secondary-prevention trials have demonstrated that aggressive lipid management can reduce the risk of future coronary events. In this supplement, we review some of those trials, the new guidelines, the concept of CHD-equivalent risk, and we will discuss the Framingham risk scoring system to predict the 10-year risk of coronary events in individual patients.- - - - - - - - - - ranking = 0.53846153846154keywords = coronary (Clic here for more details about this article) |
5/28. Coronary heart disease associated with the use of human immunodeficiency virus (hiv)-1 protease inhibitors: report of four cases and review.Four cases of human immunodeficiency virus (hiv)-infected patients who developed coronary heart disease (CHD) while under treatment with a protease inhibitor (PI) are described, and the epidemiologic and clinical features of 18 cases reported in the literature are analyzed. Cardiac manifestations mostly included myocardial infarctions. smoking and hyperlipidemia were the most common risk factors for CHD, reported in 72 and 81% of the patients, respectively. hypercholesterolemia was observed in 75% of the cases at the time of the cardiovascular event. Ninety percent of the patients with pretreatment normal lipid values experienced a rise in the plasma lipid levels during PI therapy. Although a definite relationship between the development of CHD and hiv PIs can not be made, this analysis suggests that PI-induced hyperlipidemia may play a role in accelerating coronary atherosclerosis in patients with concomitant risk factors. Evaluation and control of risk factors for CHD should be performed in each patient for whom treatment with a PI is indicated.- - - - - - - - - - ranking = 0.15384615384615keywords = coronary (Clic here for more details about this article) |
6/28. Coronary heart disease in familiar hypercholesterolemia.autopsy findings of a 36-year-old male with familiar hypercholesterolemia were reported and discussed. Hyperlipoproteinemia found in this case might belong to the type IIa in the classification of hyperlipoproteinemia while there was no skin lesion such as xanthoma and hypertension. Remarkable strictures due to atherosclerotic plaques in the lumens of the right and left coronary arteries and wide-spread myocardial infarction in the left ventricle were found. In the aorta just above the aortic valve there were atherosclerotic plaques in which foam cells could be seen. From the histological findings of the aortic valve the possibility that the thickening of the valve might have been induced by a similar mechanism as that of aorta and coronary arteries was suggested.- - - - - - - - - - ranking = 0.15384615384615keywords = coronary (Clic here for more details about this article) |
7/28. rhabdomyolysis and acute renal failure following a switchover of therapy between two fibric acid derivatives.Drug induced myopathy has been reported with the use of fibric acid derivatives, hydroxymethylglutaryl coenzyme a (HMG-CoA) reductase inhibitors and nicotinic acid. Over the last three decades, hypolipemiants like fibric acid derivatives and statins have been increasingly recognised as causes of rhabdomyolysis and acute renal failure especially during combination therapy and in the presence of underlying renal impairment. We report two cases of bezafibrate-induced rhabdomyolysis in patients with underlying coronary artery disease and pre-existing renal impairment. Both patients developed rhabdomyolysis leading to acute renal failure soon after their hyperlipidaemia treatment was changed from gemfibrozil to bezafibrate. There were no intercurrent illnesses or co-administration of other lipid lowering drugs in both patients. Even though both drugs belong to the same fibric acid derivatives group, these patients developed the complication only after a switchover of therapy.- - - - - - - - - - ranking = 0.076923076923077keywords = coronary (Clic here for more details about this article) |
8/28. Premature acute myocardial infarction in a child with nephrotic syndrome.We report a case of acute myocardial infarction in a nephrotic child. A 7-year-old boy with a 4-year history of steroid-unresponsive nephrotic syndrome due to mesangial proliferation disease presented with acute vomiting and chest pain. An electrocardiogram showed ST elevation and pathological Q waves in leads consistent with anterior and septal myocardial infarction. Subsequent cardiac catheterization showed no evidence of atherosclerotic coronary artery disease, and thrombotic occlusion of the anterior descending coronary artery was the likely cause of the event. Myocardial scintigraphy showed extensive myocardial damage. The child had no long history of extreme hypercholesterolemia or hypertriglyceridemia. The case suggests that children with long-lasting nephrotic syndrome may be at increased risk for ischemic cardiovascular events, due to hyperlipidemia as well as a hypercoagulability state. The literature is reviewed regarding the relationship between nephrotic syndrome and the incidence of ischemic heart disease.- - - - - - - - - - ranking = 0.15384615384615keywords = coronary (Clic here for more details about this article) |
9/28. Management of patients with diabetic hyperlipidemia.Hyperlipidemia is commonly observed in patients with type 2 diabetes and is also characteristic of the metabolic syndrome. We discuss the lipoprotein abnormalities in type 2 diabetes and the relation of triglyceride, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol to insulin resistance and diabetes. We also present a case study of a diabetic woman with hyperlipidemia and coronary artery disease.- - - - - - - - - - ranking = 0.076923076923077keywords = coronary (Clic here for more details about this article) |
10/28. Unique single coronary artery with acute myocardial infarction: observation of the culprit lesion by intravascular ultrasound and coronary angioscopy.We report an acute myocardial infarction in a patient with a single coronary artery. The right coronary artery arose from the middle portion in the left anterior descending artery through the transverse branch. This type of single coronary artery has not been previously reported. Moreover, this is the first report in which the culprit lesion in a patient with a single coronary artery was observed by intravascular ultrasound and coronary angioscopy. The patient underwent successful coronary stent deployment.- - - - - - - - - - ranking = 1.0769230769231keywords = coronary (Clic here for more details about this article) |
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