Acute Coronary Syndrome In HIV Naïve Patient With Low CD4 Count And No Other Significant Risk Factors: Case Report And Literature Review.

Coronary artery disease (CAD) has become the leading cause of mortality in patients with Human Immunodeficiency Virus (HIV). The typical HIV-infected patient presenting with acute coronary syndrome (ACS) is a man in his mid to late 40s. The most common presentation is an acute myocardial infarction (MI), most often with ST segment elevation. Coronary anatomy seems to be variable, with some studies showing a higher prevalence of single-vessel disease and others showing a higher prevalence of 2- and 3-vessel disease than in controls not infected with HIV.

Traumatic myocardial infarction in a young athletic patient after a football game.

Myocardial injury from blunt chest trauma can result from either direct contusion or coronary artery injury due to acute coronary syndrome or coronary dissection. Although rare, blunt chest trauma is one of the non-atherosclerotic mechanisms leading to acute myocardial infarction (MI) in patients younger than 45 years. We are reporting a case of a 36-year-old athletic man who presented with infero-lateral ST elevation MI secondary to a thrombotic occlusion of right coronary artery after a blunt chest trauma. Early recognition of myocardial infarction in patients presenting with chest trauma and differentiating it from other causes of chest pain in this setting is critical in guiding the diagnosis and management of this rare, but potentially fatal complication.

High-risk acute coronary syndrome in a patient with coronary subclavian steal syndrome secondary to critical subclavian artery stenosis.

Patients with multivessel coronary artery disease are more likely to have extensive atherosclerosis that involves other major arteries. Critical subclavian artery (SCA) stenosis can result in coronary subclavian steal syndrome that may present as recurrent ischemia and even myocardial infarction in patients with coronary artery bypass graft (CABG). In patients with concomitant severe native coronary disease, occluded saphenous venous grafts (SVG) to other arteries, percutaneous intervention on critical subclavian artery (SCA) stenosis that will compromise the blood flow to left internal mammary graft (LIMA) and left anterior descending (LAD) artery will be a high-risk procedure and may be associated with cardiogenic shock, especially in patients with preexisting ischemic cardiomyopathy. The use of percutaneous left ventricular (LV) assist device like Impella will offer better hemodynamic support and coronary perfusion and therefore results in decreased myocardial damage, maximized residual cardiac function, and lower incidence of cardiogenic shock.