Rapid progression of atherosclerotic coronary artery disease in patients with human immunodeficiency virus infection

We describe the case of a 39-year-old human immunodeficiency virus (HIV)-infected man with angiographically documented rapid progression of coronary artery disease. Over a time course of only 2 months, he developed high-grade stenosis of the left anterior descending coronary artery. The risk of myocardial infarction is increased in patients with HIV infection receiving antiretroviral therapy. However, the absolute risk is small and the marked overall benefits of antiretroviral therapy are evident. Patients receiving HIV protease inhibitors should be screened for hyperlipidemia, hyperglycemia, and hypertension. They may be candidates for lipid-lowering therapies depending on their long-term prognosis and individual risk of cardiovascular disease. Care is need because of possible drug interactions between lipid-lowering drugs and antiretroviral therapy. Invasive treatment of acute myocardial infarction does not differ from that in patients not infected with HIV. The rate of progression of coronary artery disease and the restenosis rate, however, are often unexpectedly high in these patient

Cardiac arrest in a soccer player: a unique case of anomalous coronary origin detected by 16-row multislice computed tomography coronary angiography

Anomalous origin of the coronary arteries may be present in otherwise normal subjects without clinical significance, but can also be the cause of myocardial ischemia and sudden death in both adults and teenagers. In particular, the origin of the left main coronary artery or left anterior descending artery from the right sinus of Valsalva or right coronary artery may result in compression of the vessel during or immediately after exercise. We present a unique case of coronary anomaly with four separate coronary ostia originating from the right coronary sinus in a soccer player with sudden cardiac arrest. Multislice contrast-enhanced computed tomography has emerged as a valid noninvasive method for the diagnosis of coronary artery anomal

2021 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the Asia-Pacific Region: Special Populations

Advanced age, diabetes, and chronic kidney disease not only increase the risk for ischaemic events in chronic coronary syndromes (CCS) but also confer a high bleeding risk during antiplatelet therapy. These special populations may warrant modification of therapy, especially among Asians, who have displayed characteristics that are clinically distinct from Western patients. Previous guidance has been provided regarding the classification of high-risk CCS and the use of newer-generation P2Y12 inhibitors (i.e. ticagrelor and prasugrel) after acute coronary syndromes (ACS) in Asia. The authors summarise evidence on the use of these P2Y12 inhibitors during the transition from ACS to CCS and among special populations. Specifically, they present recommendations on the roles of standard dual antiplatelet therapy, shortened dual antiplatelet therapy and single antiplatelet therapy among patients with coronary artery disease, who are either transitioning from ACS to CCS; elderly; or with chronic kidney disease, diabetes, multivessel coronary artery disease and bleeding events during therapy

Renin-angiotensin system blockade in the treatment of heart failure and the role of valsartan in this treatment

Heart failure which occurs due to various causes including primarily coronary artery diseases and hypertension is a syndrome with complex physiopathology and clinic that can impair patients' quality of life or lead to death. However, it is well known that the activation of renin angiotensin system (RAS) has an important role in the physiopathology of heart failure with reduced ejection fraction. Therefore, suppression of this system for achieving a gain in the treatment of the disease has been among prominent concerns. In this review, the place of RAS suppressive drugs and valsartan, which is an angiotensin receptor blocker, in heart failure will be examined

Postpartal Dissection of All Coronary Arteries in an In Vitro-Fertilized Postmenopausal Woman

Myocardial infarction complicates approximately I in 10,000 pregnancies. Although coronary artery dissection is the leading cause of pregnancy-related myocardial infarction during the postpartum period, the pathogenesis of coronary dissection during this period remains uncertain

Acute coronary syndrome in the elderly

The fast population ageing and the delay in the age of presentation of acute coronary syndrome (ACS) is leading to a rapid increase in the proportion of old patients with ACS. Although elderly patients with ACS deserves a specific clinical approach due to aging physiology, increased incidence of comorbidities and different patient expectations, paradoxically this patient population is usually underrepresented in clinical studies. The up-to-date European Society of Cardiology Guidelines on NSTEACS recommends an invasive strategy after taking the consideration of estimated life expectancy, comorbidities, quality of life and patients preferences. A comprehensive follow-up strategy involving cardiac rehabilitation and medical management should be implemented

Postpartal Dissection of All Coronary Arteries in an In Vitro-Fertilized Postmenopausal Woman

Myocardial infarction complicates approximately 1 in 10,000 pregnancies. Although coronary artery dissection is the leading cause of pregnancy-related myocardial infarction during the postpartum period, the pathogenesis of coronary dissection during this period remains uncertain