Not so Young at Heart: A Case Report of Acute Myocardial Infarction in a 23-year-old Young Adult

@#BACKGROUND. Acute myocardial infarction (AMI) among young people is relatively uncommon. The protection offered by a young age has been slowly taken away by the increased prevalence of risk factors for CHD in adolescents such as smoking, obesity, and lack of physical activity. CASE. This is a case of a 23-year-old male smoker with no known comorbid and heredofamilial diseases who was admitted due to sudden onset of severe, stabbing, substernal chest pain. ECG was done which showed sinus rhythm with some premature ventricular depolarizations occurring in bigeminy, and ST elevation on V4-V6, I and AVL with reciprocal ST depression on III, AVF (Fig 2) consistent with extensive anterior wall myocardial infarction. Troponin I was elevated (7.57 ng/ml). Coronary angiography was done revealing a luminal filling defect at the distal segment of the left main artery consistent with thrombus formation. The patient underwent percutaneous coronary intervention of the left main artery and left anterior descending artery with TIMI III flow after the procedure. He was then discharged improved and was advised to take his home medications with good compliance CONCLUSION. MI in younger patients does carry a better prognosis if appropriately treated to be taken into consideration when treating these young adults presenting with MI. Emphasis on the importance of secondary preventive measures should be noted.

Acute Coronary Syndrome Non-ST Elevation in a young lady

Introduction@#Acute coronary syndrome (ACS) presenting as non-ST-elevation myocardial infarction (NSTEMI) in a very young Filipina female with a maternal history of premature coronary artery disease and no comorbidities is a rare occurrence and seldom suspected. An integral approach using clinical presentation, information derived from ECG, cardiac troponin and risk assessment criteria should be used in order to arrive at the proper diagnosis and management. The other challenges encountered were angioedema secondary to clopidogrel hypersensitivity and financial constraints. These factors should be taken into consideration when deciding the short and long-term treatment especially after percutaneous coronary intervention and stenting.@*Case presentation@#A 27-year-old active, female, Filipino, single, with a normal body mass index, non-smoker nonalcoholic drinker, no use of recreational drugs, no history of previous hospitalization, and comorbidities presented with sudden onset severe angina accompanied by diaphoresis and dyspnea. She was immediately brought to a local hospital, 12LECG showed T wave inversion on the inferior leads, troponin I was positive at 0.51ng/ml (0-.08) She was given aspirin, followed by clopidogrel in which she developed periorbital edema, dyspnea and was treated immediately with intravenous hydrocortisone and maintained on cetirizine and prednisone for five days. The clopidogrel was shifted to cilostazol. A coronary angiogram was done which showed a severe coronary artery disease at proximal right coronary artery. She underwent percutaneous coronary with stenting and was discharged stable and improved.@*Conclusion@#A delay in diagnosis and management may happen in a very young Filipino female presenting with acute chest pain and no comorbidities. A family history of premature coronary artery disease is a clinical marker of risk for acute coronary syndrome. A genetic testing may further establish this relationship. The clinical presentation of typical angina, T-wave inversions on inferior leads, highly abnormal cardiac troponin and very-high-risk criteria of recurrent or ongoing chest pain refractory to medical treatment warrants an immediate invasive strategy of coronary angiogram with revascularization. An angioedema secondary to clopidogrel hypersensitivity is a rare complication and can cause reluctance in a patient. The financial capacity to maintain long term treatment of dual antiplatelet should be considered for better compliance. A shared decision making between the physician and patient is a valuable tool in facing these challenges.

A rare case of Ruptured Mycotic Infrarenal Aortic Aneurysm Secondary to Salmonella Species

Introduction@#Ruptured mycotic aortic aneurysm is a rare and life-threatening condition. An early and proper initiation of antibiotics aside from aneurysmal repair is of paramount importance. The typhidot IgG and IgM may help with this dilemma, especially when the blood culture is negative and during the waiting period for the the aortic sample result. @*Case@#A 47-year-old male Filipino with type 2 diabetes mellitus presented with severe back pain for one month and intermittent fever for three weeks. Complete blood count showed anemia and leukocytosis with predominance of neutrophils. On computed tomography of the aorta, a segmental calcification and wall discontinuity in the right posterolateral wall of the infrarenal abdominal aorta with heterogenous collection of blood in the retroperitoneal region was seen and aortic rupture secondary to mycotic aneurysm was considered. He underwent emergency abdominal aortic aneurysm repair with debridement, antibiotic lavage, aortoiliac grafting, anastomosis and omental packing. The typhidot IgG and IgM test was positive and was given ceftriaxone 2gm/IV every 24 hours for six weeks. Blood cultures did not reveal significant growth of any pathogen. The aortic wall culture showed heavy growth for salmonella species sensitive to ceftriaxone, confirming and guiding the management. He was then discharged improved.@*Conclusion@#A mycotic aneurysm secondary to salmonella should be one of the considerations in an adult male diabetic presenting with prolonged fever, abdominal and back pain with or without a tender pulsatile mass. The Typhidot test is an easy and affordable test that allows rapid detection of salmonella infection. Early surgical intervention and antibiotics are the treatment of choice

Superior Mesenteric Artery Syndrome: A rare and unusual cause of Gastrointestinal Obstruction

Introduction@#Superior mesenteric artery (SMA) syndrome is a rare and unusual acquired cause of functional duodenal obstruction whose diagnosis can be easily missed without knowledge of this condition.@*Case Presentation@#We report a case of a 27-year-old female, presenting with post-prandial vomiting, early satiety, bloatedness and weight loss for about 10 months. Vital signs were stable. She was grossly underweight with a BMI of 11.72 kg/m2 (height=1.6m, weight=30kg). Physical examination was unremarkable. Gastrointestinal series revealed a narrowing in the third portion of the duodenum likely secondary to extrinsic compression. Contrast-enhanced CT scan of the whole abdomen was performed with 3D reconstruction. There were no definite signs of gastrointestinal obstruction. However, a narrow/acute aorto-mesenteric angle of 13 degrees compressing the third part of the duodenum was noted. Superior mesenteric syndrome was considered, prompting further work-up. Primary hyperthyroidism was the root cause of the patient’s weight loss that lead to this condition. Patient was given nutritional support, parenterally and enterally. She was discharged improved after oral feeding was tolerated and patient started to gain weight. @*Discussion@#Superior mesenteric artery (SMA) syndrome is an uncommon medical condition brought about by a decrease in the aortomesenteric angle from the usual 45o to less than 15o resulting in vascular compression of the third part of the duodenum leading to gastrointestinal obstruction. A high index of suspicion is needed to prevent the diagnosis from being missed which may in turn lead to unnecessary testing and treatment. If recognized early, the condition may be managed conservatively. Surgical management is only required when conservative methods fail.@*Conclusion@#Early recognition and a thorough evaluation is therefore imperative so conservative measures can be maximized at the outset.