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BMJ Case Rep ; 15(5)2022 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-35589263

RESUMO

We present a man in his 30s with acute anterior myocardial infarction due to thrombotic occlusion of the left anterior descending artery and subsequent left ventricular thrombus formation after high-dose recreational use of nitrous oxide (N2O). Initial questioning for use of illicit substances was negative, but low vitamin B12 levels and severely elevated homocysteine levels prompted us to interrogate for the use of laughing gas. On questioning, the patient admitted to have used this substance, which he presumed to be innocent. Neither percutaneous coronary intervention with balloon dilatation nor intravenous glycoprotein IIb/IIIa receptor antagonist, nor continuous use of anticoagulation and double antiplatelet therapy resulted in thrombus resolution. Due to a severely reduced left ventricular function, despite 3 months on heart failure therapy, the patient is being counselled for intracardiac defibrillator implantation. We conclude that N2O, notably when consumed in conjunction with other proatherogenic substances, is associated with thrombosis: a relation possibly mediated by severe hyperhomocysteinaemia.


Assuntos
Trombose Coronária , Infarto do Miocárdio , Trombose , Trombose Coronária/induzido quimicamente , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/tratamento farmacológico , Vasos Coronários , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Óxido Nitroso/efeitos adversos , Inibidores da Agregação Plaquetária/efeitos adversos , Trombose/tratamento farmacológico
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