Acute coronary syndrome at a patient with systemic sclerosis fast progressive

Objective: T he purpose of this paper is to expose a particular clinical case of a young patient who associ-ate acute coronary syndrome – NSTEMI with an au-toimmune connective tissue disease (progressive syste-mic sclerosis with diffuse cutaneous damage, articular damage and vascular damage with Raynaud’s pheno-mena). We mention that the patient was recently di-agnosed with the connective tissue pathology (March 2019), but has joint symptoms since December 2018, he is currently being treated with Metotrexate and Prednison. As traditional cardiovascular risk factor, our patient is a smoker.

Methods: A 51-year-old patient is presented at the emergency room with chest pain associated with short-ness of breath. The ECG reveals repolarisation disor-ders with ST-T depression, suggestive of subendocar-dial ischemia in antero-septal territory. The transtho-racic echocardiography reveals kinetic disorders with hipokinesia in antero-septal territory and preserved left ventricular ejection fraction, with normal right ca-vities, without pulmonary arterial hypertension. The troponine dynamic change is suggestive for acute myo-cardial infarction. The patient associate also, inflamma-tory syndrome with increased ESR and fibrinogen. Results: A coronarographic investigation was performed: trivascular diffuse atheromatosis was found (di-ffuse calcificated left anterior descending artery in the middle and proximal segments with stenosis of 50%, circumflex artery with diffuse atheromatosis without any stenosis, right coronary artery with 30% stenosis at the ostial level), the lesion are without any hemodyna-mic significance, but a critical stenosis of 90-95% is pre-sent in the middle segment of the intermediate branch, this stenosis was treated with primary coronary angioplasty with pharmacologically active stent implan-tation. We have expended our investigations to assess the degree of ventilator dysfunction by performing a thoracic CT showing pulmonary fibrosis and multiple micronodules, together with complex ventilation sam-ples showing normal ventilator flows and slightly low alveolar capillary diffusion.

Conclusions: Systemic sclerosis is an autoimmune di-sease of the conjunctival tissue associated with macro and microvascular disorders. Systemic inflammation causes an increase in the prevalence of systemic athe-rosclerosis. Studies have shown that the pathogenesis of atherosclerosis in chronic inflammatory diseases is the endothelial cell dysfunction, aggravated by tradi-tional risk factors. The coronary lesions at this patient were atherosclerotic.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)