Acute myocardial infarction in young patients: the culprit is not always a ruptured atherosclerotic plaque

Simultaneous Ipsilateral Floating Hip and Knee: A Complex Combination and Difficult Surgical Challenge

Simultaneous ipsilateral floating hip and floating knee are extremely rare. To the best of our knowledge, only four cases have been described in the literature. This uncommon injury is mostly caused by high-velocity impact and associated with life-threatening lesions. We report a unique case of concomitant ipsilateral floating hip and floating knee following road traffic accident. The patient presented ipsilateral hip dislocation and acetabular, femoral, and tibial fractures associated with chest trauma. The aim of this report is to highlight the severity and rarity of this combination and to describe the therapeutic recommendations.

Angina pectoris or myocardial infarctions, pulmonary arteriovenous malformations, hereditary hemorrhagic telangiectasia, and paradoxical emboli

Hereditary hemorrhagic telangiectasia is an autosomal dominant disorder characterized by vascular malformations, and many clinical complications are related to pulmonary arteriovenous malformations (PAVMs) because they provide direct right-to-left shunts. Paradoxical emboli through these shunts are a well-recognized cause of transient ischemic attack, stroke, and cerebral abscess. The aim of this study was to determine whether paradoxical emboli through PAVMs could manifest as cardiac ischemic events. The study included a single-center population of 98 patients with PAVMs. Eighty-four had undergone PAVM embolotherapy, and the remaining 14 patients had PAVMs too small to require embolization. Patients were interviewed by telephone and surveyed regarding their cardiopulmonary symptoms and histories of cardiac diagnoses. We found that 6 patients (which is 18% of patients with symptomatic PAVMs, n = 33, and 6% of the total cohort, n = 98) reported that they had experienced typical angina pectoris-like chest pain or had a myocardial infarction before PAVM embolotherapy. Five patients had had a cardiac catheterization, 4 had normal coronary arteries, and 1 had a single artery occlusion. In conclusion, we suggest that in patients with untreated PAVMs, cardiac ischemia can occur because of a paradoxical embolus through PAVMs to a coronary artery.

Comparison of clinical features and outcomes of patients with acute myocardial infarction younger than 35 years with those older than 65 years

PURPOSE

The objective of this study was to analyze the clinical characteristics of patients younger than 35 years with acute myocardial infarction (AMI).

METHODS

A total of 117 patients younger than 35 years with AMI admitted to the hospital during the recent 10 years were chosen, and 355 patients older than 65 years with AMI served as a control group. The case history, clinical data, coronary angiography and prognosis of the patients were analyzed and compared.

RESULTS

Among the younger patients with AMI, men (96.6%) and those smoking cigarettes (66.7%) account for the majority. ST-segment elevation (69.2%) and anterior wall infarction (43.6%) were more prevalent in the younger patients than in the older patients. Compared with the older patients, the younger patients had a higher level of low-density lipoprotein cholesterol (2.93 ± 1.48 versus 2.35 ± 1.21, P = 0.0428) and higher left ventricular ejection fraction (59.82 ± 10.86 versus 48.31 ± 12.48, P = 0.0396). Coronary angiography data showed that most of the younger patients were characteristic of having single-vessel lesion (66.7%), left anterior descending artery lesion (69.3%) and coronary artery spasm more than the older patients (6.8% versus 0.56%, P = 0.0001). In addition, the in-hospital mortality, and the prognosis after 1 and 12 months in the younger patients were comparatively better.

CONCLUSIONS

The main risk factors for young adults aged <35 years with AMI include cigarette smoking, hyperlipidemia and family history of coronary artery disease, and smoking cessation and lifestyle improvement are important considerations for the prevention of this disease in this population.