jueves, 2 de abril de 2009

17.-FAMILIAL MYOCARDIAL INFARCT.PROF. GARFIA. A

17.-SUDDEN CARDIAC DEATH DUE TO SEVERE CORONARY ATHEROSCLEROSIS IN A YOUNG MAN -26 YEARS OLD.
PROF. GARFIA.A


CASE REPORT


   A 26 year old patient who died as a consequence of myocardial infarction in the presence of witnesses. Two weeks earlier he had visited his family doctor for pain in his shoulder and left arm, which was diagnosed as muscular strain for which the patient was recommended to place his arm in a sling
     The pathological study showed the existence of a myocardial infarct in the interventricular septum and the scar was two weeks old.The left circumflex coronary and the anterior descending arteries, presented severe atheromatous stenosis, of more than 90%. Among the points of interest in the family history, the existence of two episodes of myocardial infarction with hospitalization in the Intensive Care Unit of the victim's elder brother, aged 32 years, due to a myocardial infarct and the death of a first cousin 28 years old - also due to myocardial infarction - were significant. 
     Given the youth of the deceased and his family history, the convenience of carrying out a lipid study was suggested to the family, in view of the suspicion of possible familial hiperlipidaemia.The results of the autopsy, together with the familiy history, the biochemical and the lipid study carried out pointed to the existence of a Combined Primary Familial Hiperlipidaemia. 
    Other possibility to explain the severe atheromatous lesions found in this case would be the existence of an abnormal elevation of Lipoprotein (a) ( > 0.3 g/L), - considered by numerous authors an independent risk factor to have conditioned the apparition of a severe atherosclerotic coronariopathy and sudden cardiac death in young people- was unfortunatelly not determined in this case.







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PROF. GARFIA.A


Photo 1.- 26 year old patient. The left anterior descending coronary artery showing severe lumen narrowing due to coronary atherosclerosis (arrow). The red line inside the artery show the residual arterial lumen. Prof.Garfia.A








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 Photo 2.-Microscopical aspect of the same artery showing the severe narrowing of the lumen ( more of 90%) due to the existence of a fibroatheromatous plaque with fibrin deposition (arrows), probably dependent of the organization of a previous trombus (L=lumen). Prof.Garfia.A



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Photo 3.- Microscopical section of the left circumflex coronary artery showing a severe narrowing of the lumen due to the existence of a typical fibrous cap atheroma which contains a necrotic core containing cholesterol clefts, foam cells and fibrous tissue.Prof.Garfia.A






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Photo 4.- Right coronary artery. It shows intimal hyperplasia -with fibrous tissue and foam cells- but the reduction of the arterial lumen (L) is not so severe than in the others coronaries arteries. Focal preatheromatous lesion.
Prof.Garfia.A



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Photo nº.-5.- Showing an intramyocardial arteriole which presents a thicker muscular wall -and penetration of connective tissue from the adventitia- for the age of the patient. Prof.Garfia.A



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Photo nº.6.- This section of the heart shows the localization of the myocardial infarct (arrows) in the interventricular septum.Prof.Garfia.A



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Photo nº. 7.- The mycroscopical study of this area demonstrated the existence of a myocardial infarct -aproximatelly two weeks old- due to the presence of granulation tissue plenty of macrophages cells with cellular debris and neocollagen fibers formation. (IAM= myocardial infarct). 
Prof.Garfia.A