Balkan Medical Union Founded in 1932 as “L’Union Medicale Balkanique” Officers of the Balkan Medical Union Honorary Secretary General V. Cândea, Romania Secretary General V. Sârbu, Romania
Presidents of regional sections
On the cover:
Albania:
Y. Popa
Bulgaria:
G. Gorchev
Cyprus:
V. Lyssarides
Greece:
G. Androutsos
FIR Macedonia:
N. Ivanovski
Moldova:
Gh. Ciobanu
Romania
Daniela Bartoæ
Turkey:
S. Ergüney
Serbia:
Vladmila Bojanić
HORMONE RECEPTORS VERSUS APOPTOTIC AND PROLIFERATIVE MARKERS IN ENDOMETRIAL CARCINOMA
Author:
Anca Potecã, Maria Comãnescu, T. Potecã, Adelina Birceanu, Maria Sajin
Comments:
Immunohistochemical expression of ER, obx10. Immunohistochemical expression of PR, obx10 Immunohistochemical expression of Ki67, obx40. Immunohistochemical expression of bcl-2
Indexed in: EMBASE/Excerpta Medica / SCOPUS Chemical Abstractss
Archives of the Balkan Medical Union Copyright © 2014 CELSIUS
vol. 49, no. 4, pp. December 2014
CASE REPORT
ANOTHER CASE OF ACUTE MYOCARDIAL INFARCTION? G.R. MAXIM¹, IRINEL RALUCA PAREPA¹,², ELENA DUMEA², ANDREEA BOSNEAGU¹, MIHAELA CIUCEA¹, D.E. GEORGESCU³, SIMONA CLAUDIA CAMBREA² ¹Clinical Emergency Hospital „Sf. Apostol Andrei”, Constanåa, Romania ²„Ovidius”, University, Faculty of Medicine, Constanåa, Romania ³„Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
S UMMARY
R ÉSUMÉ
This article presents a case of a 60-year-old man, with multiple atherosclerotic lesions (carotid, coronary) and that, despite an optimal ambulatory treatment and a very good control of the conventional cardiovascular risk factors, is hospitalized for a new acute myocardial infarction. In this article we want to emphasize the importance of the new cardiovascular risk factors, unconventional, and also the necessity to be evaluated in current medical practice. Key words: atherosclerosis, acute myocardial infarction, conventional, unconventional, cardiovascular risk factors
Cet article présente le cas d'un patient de 60 ans, avec de multiples lesions athérosclérotiques (carotide, coronaire) et que, malgré un traitement ambulatoire optimal et un très bon contrôle des facteurs de risque cardio-vasculaires conventionnels, a été hospitalisé pour un nouvel infarctus aigu du myocarde. Dans cet article, nous voulons souligner l'importance de ces nouveaux facteurs de risque cardio-vasculaires, non conventionnels, et la nécessité d'être évalués dans la pratique médicale courante. Mots clés: athérosclérose ;infarctus aigu du myocarde; facteurs de risque cardio-vasculaires conventionnels, non conventionnels
I NTRODUCTION
atherosclerosis process will manifest later, especially in the coronary territory. In January 2014, he is admitted to the hospital for prolonged chest pain, after a low intensity effort, without resting electrocardiogram changes associated, but with slightly elevated markers of myocardial necrosis (hS Troponin I test positive). At that time, coronary angiography revealed a long stenosis of maximum 80% in the medium portion of the anterior descending artery, 60% stenosis with a soft plaque aspect in the right coronary artery segment 2, 40-50% eccentric plaque in the right coronary artery segment 3 and 50% plaque in the circumflex artery after MG 1. The injection of contrast material in the carotid arterial system has revealed occlusion of the left internal carotid artery at the origin and ulcerated plaque in the proximal right internal carotid artery. In March 2014, elective percutaneous coronary revascularization was performed with pharmacologically active
ardiovascular diseases and their complications represent the leading cause of mortality worldwide. Underlying cause of these diseases is atherosclerosis, a systemic disease affecting all vascular beds in the organism. It becomes manifest after a long asymptomatic period, often the first manifestation is a redoubtable complication (myocardial infarction, stroke, peripheral arterial occlusion) [1, 2, 3].
C
C ASE
REPORT
We present a case of a 60-year-old man patient with multiple cardiovascular risk factors (smoking, essential arterial hypertension, dyslipidemia, diabetes mellitus type 2). Symptomatic since 2007 by left Sylvian ischemic stroke,
Correspondence address:
Irinel Raluca Parepa MD, Ph.D University lecturer, Clinical Emergency Hospital „Sf. Apostol Andrei” Bd Tomis nr. 145, 900591, Constanåa, Romania e-mail:
[email protected]
ANOTHER CASE OF ACUTE MYOCARDIAL INFARCTION? - MAXIM et al
vol. 49, no. 4, 520
stent implantationin the medium portion of the anterior descending artery. It follows a period without angina under treatment with beta-blockers, dual antiplatelet therapy (aspirin 100 mg/day and clopidogrel 75 mg/day), hypolipemiant (atorvastatin 40 mg/day), angiotensinconverting-enzyme inhibitor and dihydropyridinecalcium channel blockers, with effective control of cardiovascular risk factors. In August 2014, the patient is admitted to the hospital for intense chest pain at rest, irradiated in bilateral upper extremities, with onset of 40 minutes prior to the presentation. (Clinical manifestations of acute myocardial infarction with ST-segment elevation in the inferior territory, Killip class I)[4]. Physical examination: Obesity grade I, pale and sweaty skin, BP=120/80 mmHg, equal bilateral, HR=60 bpm, regular rhythm, without cardiac and vascular murmurs, no signs of pulmonary or systemic congestion. Blood tests: suggestive dynamics of the myocardial necrosis markers, hyperglycemia (serum glucose levels 116/123 mg/dl),altered lipid profile (total serum cholesterol 150 mg/dl, LDL cholesterol 68 mg/dl, triglycerides 119 mg/dl). Resting ECG reveals sinus rhythm, heart rate of 75 bpm, ST segment elevation of cca. 3 mm in DII, DIII and aVF; and ST segment depression in DI, aVL, V2-V5. Transthoracic echocardiography shows mild concentric left ventricular hypertrophy, inferior wall LV hypokinesia, preserved global systolic function (EFLV=60%), diastolic dysfunction with impaired relaxation pattern, mild mitral regurgitation, mild tricuspid regurgitation.
Coronary angiography reveals: progression of the lesion in the right coronary artery – stenotic lesion > 90% with thrombotic aspect, in the medium segment of the right coronary artery; 70-90% stenosis in the distal segment of the right coronary artery (fig.1); anterior descending artery with patent stent in the medium segment, but with 50-70% distal stenotic lesion (fig. 2); and circumflex artery showing a 50-70% stenosis in the proximal segment and 90% with thrombotic aspect, in the medium segment of the right coronary artery; 70-90% stenosis in the distal segment of the right coronary artery.
Figure 2 - anterior descending artery with patent stent in the medium segment, but with 50-70% distal stenotic lesion.
D ISCUSSION Multiple scientific evidence argue that atherosclerosis can be slowed, halted, even reversed, by specific therapeutic measures, the more effective the earlier applied. Early diagnosis of atherosclerosis in asymptomatic phase is of great importance for the prevention of cardiovascular disease [5]. This case is distinguished by: - multiple risk factors (age, arterial hypertension, dyslipidemia, diabetes) common of atherosclerosis with various locations - lesions of atherosclerosis, symptomatic, in at least two vascular territories (coronary and carotid - cerebral ).
Archives of the Balkan Medical Union
Figure no. 3 - circumflex artery showing a 50-70% stenosis in the proximal segment and
