Acute coronary syndrome – clinical-evolution particularities

Introduction: Acute myocardial infarction is a major cause of mortality and morbidity worldwide despite progress in correction of cardiovascular risk factors and myocardial revascularization therapy. Mortality of patients with STEMI is influenced by multiple fac-tors including age, Killip class, therapeutic strategy, the presence of a history of myocardial infarction, renal failure, and the number of affected coronary arteries. The prognosis in acute myocardial infarction was sig-nificantly improved with the introduction of early per-cutaneous coronary reperfusion strategies in acute ST segment elevation myocardial infarction. In Europe, the annual incidence of acute myocardial infarction varies between 44 and 142 cases / 100.000 inhabitants. Methods: We present the case of a 45-year-old pati-ent with significant cardiovascular heredo-collateral history (hypertensive father and a brother who died from acute myocardial infarction), known with mul-tiple cardiovascular risk factors, hypertensive at age 30 (declarative – during the last pregnancy, maximum blood pressure 200/100 mmHg), dyslipidemic, smo-ker, known with chronic venous insufficiency Class III CEAP and chronic heart failure Class II NYHA, with short-acting nitrate treatment at home, given during the crisis angina, is admitted urgently for anterior chest pain of very high intensity, with interscapulovatebral irradiation, with onset of approximately 36 hours befo-re presentation in hospital.

Results: Investigations carried out during hospitali-zation revealed the presence of an acute myocardial infarction in the anterior and inferior territory (rein-farction in the same territory), expressed by important electrocardiographic and echocardiographic changes, evidenced by the parietal segmental kinetics disorders (full-length hipokinetic septum, akinetic 1/3 apical, as well as severe hypokinesis of the lower wall), but also biologically by the increase of myocardial cytolysis enzymes. The scintigraphic myocardial perfusion exa-mination performed under resting conditions with the patient under treatment with calcium blocker, be-ta-blocker, double platelet aggregation, low molecular weight heparin, statins, loop diuretic, revealed severe hipokinesis of anterior, septal and lower wall, as well as moderate apical hypokinesis with left ventricular ejection fraction within normal range. Under complex therapy, clinical and biological evolution was slowly fa-vorable, but marked by the post-infarction angora in the first 7 days of hospitalization.

Conclusions: The clinical, diagnostical and therapeu-tical approach must integrate the overall spectrum of patient comorbidities. Management of patients with STEMI in the early phase is an essential element for prognosis, but on the other hand, reperfusion therapy is effective if applied earlier. The objectives of the treat-ment of ischemic heart disease aim on the one hand to improve the life quality by eliminating painful episodes and limiting exercise capacity and, on the other hand, avoiding complications that reduce long-term survi-val. The current trend is to address coronary pathology through interventional therapy, but also to prevent li-festyle changes and correction of coronary risk factors.

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