ABSTRACT
We report the case of a 40-year-old HIV-positive man, undergoing three-drug antiretroviral therapy for 2 years that included a protease inhibitor (ritonavir). The patient was admitted to our Coronary Care Unit with an acute anterior myocardial infarction. He smoked 20 cigarettes/day and had a family history of hypertension. At the time of hospitalization, triglyceride levels were found to be high (290 mg/dl). Metabolic alterations associated with the prolonged use of protease inhibitors, such as insulin resistance, dyslipidemia and lipodystrophy, have recently been described. This side effect may lead to premature coronary artery disease. Therefore it is mandatory to be aware that treatment with protease inhibitors in HIV-positive patients, despite survival prolongation and lowering of AIDS complications, may accelerate atherosclerosis and precipitate acute coronary events, especially in patients with pre-existing cardiovascular risk factors.
Subject(s)
HIV Infections/drug therapy , Hypertriglyceridemia/chemically induced , Myocardial Infarction/etiology , Reverse Transcriptase Inhibitors/adverse effects , Ritonavir/adverse effects , Adult , Anti-HIV Agents/therapeutic use , Didanosine/therapeutic use , Drug Therapy, Combination , Humans , Hypertriglyceridemia/complications , Hypertriglyceridemia/drug therapy , Male , Reverse Transcriptase Inhibitors/therapeutic use , Ritonavir/therapeutic use , Stavudine/therapeutic useABSTRACT
In the last decade advances in cardiovascular research improved remarkably our understanding of coronary heart disease. However many important problems are so far unresolved. In the present study we focused on the "natural" history of ischemic heart disease in a group of 114 patients. One hundred-seven patients had recent myocardial infarction, and seven suffered from angina. They were observed for a mean period of five years (one to 168 months). Forty-nine patients (42.9%) had no coronary events; sixty-five had angina, myocardial infarction or both. The myocardial infarction was however rare (five cases). The most frequent presentation of angina was stable and effort angina, which sometimes subsided after a period of presence. The classification of angina was often very difficult in cases of effort angina with very low threshold. No relevant differences were found between patients with and without coronary events according to age, sex, duration of follow-up, location of previous myocardial infarction. A significant difference was found in the prevalence of risk factors only for hypertension, which was more frequent in patients with coronary events. Smokers were more frequent in group without coronary events. In our opinion, the most interesting conclusion is that, almost half of these patients remained completely asymptomatic for a very long period.
Subject(s)
Angina Pectoris/etiology , Coronary Disease/etiology , Myocardial Infarction/etiology , Myocardial Ischemia/etiology , Adult , Aged , Ambulatory Care , Angina Pectoris/diagnosis , Coronary Disease/diagnosis , Diabetic Angiopathies/complications , Female , Follow-Up Studies , Humans , Hypercholesterolemia/complications , Hypertension/complications , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Ischemia/diagnosis , Risk Factors , Smoking/adverse effectsABSTRACT
The incidence of hypotension in patients treated with thrombolytic agents for myocardial infarction was investigated in a series of 71 patients, 17 treated with urokinase, 35 with rtPA and 19 with APSAC. Hypotension was observed in 23.5% of the first group, in 5.5% of the second, and in 42.10% of the third (p < 0.002 between rtPA and APSAC). In the inferior location hypotensive reaction was much more frequent than in anterior one (p < 007) especially if a right ventricular involvement was associated. Even if hypotension is a minor and generally harmless complication, it poses many practical problems, and its occurrence must be taken into account when choosing a fibrinolytic treatment.
