From the backstage of the atherosclerosis patient – between the predictability and the unpredictability of the vulnerable plaque

Introduction: Initiated in childhood or adolescen-ce, atherosclerosis evolves with plaque development in distinct chronological phases. Later, atherosclero-tic disease becomes evident through stable chronic or acute thromboembolic manifestations such as arterial thrombosis, acute coronary syndrome, acute ischemic stroke, peripheral or visceral ischemia.
Methods: We present the case of a 78-year-old patient with multiple cardiovascular risk factors: former hea-vy smoker, hypertensive, dyslipidemic, stroke sechelar, with reduced atrial fibrillation, chronic tricoronarr-hean ischemic cardiopathy, obliterating arteriopathy, left inner carotid stenosis (endarterectomy 2015). He is directed to „Sf. Spiridon“ Hospital, Iasi for ischemic type abdominal pain (episodic night or effort related worsening, with no relation to food intake, accompa-nied by profuse sweating) followed by antero-lateral chest pain (duration <5 minutes, spontaneously yiel-ding), headache and elevated arterial pressure. The symptoms appeared one year ago, but worsened over the last 3 days.
Imaging tests and upper gastric endoscopy (for the associated anemia) excluded a digestive cause for the abdominal pain. A slight improvement in symptoma-tology under treatment with angiotensin converting enzyme inhibitor, calcium channel antagonist and sta-tin was obtained. The angio-CT exploration of the ab-domen detects an upper mesenteric artery thrombosis with favorable progression under anticoagulant thera-py. Six months later the patient develops two synco-pal episodes in a 3 months interval, accompanied by uncontrolled arterial pressure who required repeated hospitalizations. A new thoraco-abdominal angio-CT confirmed the suspicion of aortic dissection. In spite of these challenges, under anticoagulation treatment star-ted after highlighting of mesenteric arterial thrombosis and subsequently reconsidered, the short and medium-term evolution was favorable.
Conclusions: In this context, in the face of a vulnera-ble patient with a predisposition to acute thrombotic events, choosing the optimal therapeutic strategy for prevention along with the treatment of arterial throm-bosis and complications becomes the key to unstable plate management.

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)