Risk factors for myocardial infarction in young women

Seventy-seven women discharged from hospital with a diagnosis of myocardial infarction and 207 control patients were investigated. All were under 45 years of age at the time of admission. Heavy cigarette smoking, reported treatment for pre-eclamptic toxaemia, and type II hyperlipoproteinaemia were found to be independent risk factors for myocardial infarction. Reported treatment for hypertension and diabetes are probably also independently associated with subsequent development of the condition, but the associations between myocardial infarction and reported treatment for obesity and psychiatric illness appear to be secondary. Previous publications have suggested that use of oral contraceptives is an independent risk factor. Examination of the effect of several factors combined, suggests that they act synergistically, the presence of three or more factors increasing the risk 128-fold.     

Acute myocardial infarction in a young woman with systemic lupus erythematosus

A 49-year-old diabetic patient with abdominal pain was found upon ultrasonography and computed tomography to have a cystic mass in the head of the pancreas with dilation of the main pancreatic duct. The head of the pancreas and duodenum were removed surgically. Examination of the operative specimen showed chronic pancreatitis, dilation of the main pancreatic duct, and impacted mucus in the secondary ducts with villous proliferation of the ductal epithelium, establishing the diagnosis of intraductal adenomatosis. There was no evidence of malignancy. The resection margin was involved, and consequently the remainder of the pancreas was removed six months after the initial surgical procedure. A review of the literature showed that intraductal adenomatosis tends to spread and carries a high risk of malignant transformation. Surgery is required because of the risk of pancreatic duct obstruction and pancreatic cancer. Intraductal adenomatosis of the pancreas shares many characteristics with other adenomatous proliferations of the gastrointestinal tract (colorectal villous adenoma, bile duct adenomatosis), including presence of villous structures with increased mucus production, a tendency to spread massively, and a high risk of malignant transformation.     

Fatigue in women with myocardial infarction

This study measured fatigue in women 6 weeks after myocardial infarction. Fatigue was experienced by the women as chronic, generalized, intermittent, and longstanding. More than one third of the women attributed their fatigue directly to the heart attack or hospitalization. Significant relations were found between fatigue and the physiological dimension of the Sickness Impact Sale (SIP), the Perceived Health Assessment and Risk Protection Survey (PHARPS), and the site of infarction, as well as with the psychological dimension of the SIP. There was an inverse significant relation between fatigue scores and the Psychological General Well-Being (PGWB) Index. Although not reaching statistical significance, fatigue scores for women 65 and older were higher than for younger women.     

Acute myocardial infarction in two adolescent males

Acute myocardial infarction in previously healthy children is rare in the absence of congenital anomalies. We describe two cases of acute anterior myocardial infarction in adolescent males with no congenital heart disease, without prior history of or risk factors for coronary heart disease, and with no history of drug abuse. These cases illustrate that myocardial infarction in the absence of systemic illness or coronary anomalies can occur in an adolescent population.     

Acute myocardial infarction in a previously healthy adolescent

Acute myocardial infarction in an adolescent is rare, with most episodes occurring in individuals with preexisting traumatic or medical conditions. Acute myocardial infarction in a previously healthy adolescent is an even more rare event. This report details such an event and briefly reviews the recent medical literature.     

Acute myocardial infarction: failed thrombolysis revisited

The prognosis following acute myocardial infarction is dependent upon the presence of adequate blood flow in the infarct-related vessel. All too often, this is not achieved by thrombolytic therapy ('failed thrombolysis'). Diagnosis of failed thrombolysis is difficult and the optimum management is currently unclear.     

Acute myocardial infarction: prognosis after recovery

A prognostic index for 2-year survival after recovery from acute myocardial infarction was constructed from variables obtained during its course. One hundred ten of 143 patients survived 2 years, and 27 of 33 patients died of cardiac-related causes. Univariate analysis showed that 12 variables were significantly different between the surviving and nonsurviving groups. Discriminant analysis indicated five variables with meaningful predictive value to be included in a prognostic index: admission systolic blood pressure; highest blood urea nitrogen level in the cardiac care unit: atrial arrhythmias in the cardiac care unit; angina pectoris for more than 3 months or a previous myocardial infarction; and more than one ventricular ectopic beat per hour recorded on a dynamic electrocardiogram during the 17th to 24th hospital day. The prognostic index emphasizes the importance of extensive myocardial impairment and provides a means for identifying patients at risk of early mortality.     

Acute myocardial infarction and myocardial bridging: a case report

OBJECTIVE: To describe the appearance and frequency of skeletal abnormalities associated with the Marinesco-Sj?gren syndrome of cerebellar ataxia, congenital cataracts, mental and physical retardation and myopathy. SUBJECTS AND METHODS: Seventeen individuals affected with the disorder, of common ancestry and marked consanguinity, were found in an isolated area in southwest Alabama; 11 were available for radiologic examination of parts of the skeleton. The range and frequency of skeletal abnormalities thus demonstrated were tabulated. RESULTS AND CONCLUSION: A constellation of cranial and extracranial skeletal abnormalities-including a small posterior fossa, spinal abnormalities, gracile bones, elbow and hip valgus and asymmetric metacarpal and metatarsal shortening- can lead the radiologist or orthopaedist to suggest the diagnosis, especially if appropriate neurological/neuroradiological findings also are present.     

Peculiarities of myocardial infarction at young age in Southern Croatia

The aim of this study was to assess whether acute myocardial infarction (AMI) in younger patients (< 45 years) differs from that in the older individuals (> 45 years). We have studied the records of all patients admitted to the Department of Medicine, Clinical Hospital of Split, Croatia, because of AMI from January 1st, 1987 to December 31st, 1991. The study group consisted of 1406 patients, 130 (9.2%) below, and 1276 (90.8%) above the age of 45. In the ?young? subgroup there were only 9 females (6.9%), significantly less than in the ?old? one (399 out of 1276 or 31.3%, p < 0.001). There were many more smokers among the younger (100 out of 130 or 76.9%) than among the older patients (524 out of 1276 or 41.1%, p < 0.001). The location of myocardial necrosis was also different: inferior infarction occurred in 65 out of 130 or 50% young patients and in 442 out of 1276 or 34.6% old patients; p < 0.001). Finally, the hospital mortality rate among the younger AMI patients was quite low (8 out of 130 or 6.2%) when compared to that of the older patients (282 out of 1276 or 22.1%, p < 0.001). In conclusion, AMI in younger individuals shows relevant peculiarities: the background of such patients almost invariably includes cigarette smoking; the female gender is about five times less affected, the diaphragmatic location is nearly two times more frequent, and the hospital mortality rate of these patients is almost four times lower than that of older patients.     

Acute myocardial infarction secondary to Wegener''s granulomatosis]

Previous experiments discovered high rates of chromosomal rearrangements in the progeny of males containing a telomeric segment of Drosophila koepferae in a D. buzzatii genetic background (segmental males). We have performed similar experiments, designed to test whether this chromosomal instability could be explained by a phenomenon similar to P-M hybrid dysgenesis or, alternatively, by a generalized telomeric effect. However, the results obtained have not allowed us to fully characterize this process, because we have not observed chromosomal rearrangements in the progeny of the putative unstable males. Our results suggest that chromosomal instability is independent of the introgressed fragment. A reasonable hypothesis to explain these results is that mutator factors are occasionally introduced by the hybridization. The effect of sampling, caused by the fact that only a small region is introgressed in a particular line, may explain why only some hybridizations lead to instability.     

Cerebral infarction in young women: analysis of 130 cases

Between January 1993 and September 1996, 50 patients underwent isolated subtotal turbinectomy (without associated septal intervention). This retrospective study analyzes the short and long-term subjective results after a mean 24-month follow-up. Surgery was successful in 80% of cases yielding good nasal repermeabilization. Rhinorrhea and post nasal drip were improved in 30% of cases. Facial pains and hyposmia were improved in 71% and 89% respectively. No cases of crusting rhinitis were observed. Subtotal inferior turbinectomy, although it has raised some controversy, is the treatment of choice for the patients suffering from chronic rhinitis related to hypertrophy of the inferior nasal conchae resistant to medical treatment.     

A common prothrombin variant (20210 G to A) increases the risk of myocardial infarction in young women

Using specimens from a population-based case control study among women ages 18 to 44 years in western Washington, we assessed the relationship between carriership of a genetic clotting factor II variant (20210 G-->A) and myocardial infarction (MI). The factor II variant was previously shown to be present in 1% to 2% of the population, to increase the levels of factor II, and to be associated with venous thrombotic disease. Personal interviews and blood samples were obtained from 79 women with a first myocardial infarction and 381 control women identified through random-digit telephone dialing. Polymerase chain reaction (PCR) method was used to determine the factor II genotypes. The factor II 20210 G to A transition was present more often in women with MI (5.1%) than among control women (1.6%). The age-adjusted odds ratio for MI was 4.0 (95% confidence interval 1.1 to 15.1). The relative risk was high when another major cardiovascular risk factor was also present, such as smoking (odds ratio 43.3, 95% confidence interval 6.7 to 281), and the risk seemed limited to those with other risk factors. These results, in which the effect of major coronary risk factors is enhanced fourfold to sixfold by the prothrombin variant, are similar to those previously reported for another genetic clotting abnormality, factor V Leiden. We conclude that factor II 20210 G to A increases the risk of myocardial infarction in young women, especially in the women with other major risk factors for coronary heart disease.     

Acute myocardial infarction due to vasospasm in a 13-year-old-boy

We describe an unusual case of acute myocardial infarction due to vasospasm in a 13-year-old boy. He was admitted to our hospital with severe congestive heart failure and shock. He had experienced a feeling of chest oppression with dyspnea while running, which grew worse. He then lost consciousness and was brought by ambulance to our intensive care unit. He had had similar but milder episodes of chest oppression months earlier. The family history revealed that his father had died suddenly from hypertrophic cardiomyopathy and that his grandmother also had hypertrophic cardiomyopathy. On admission, the patient was bathed in a cold sweat, his pulse was weak, and his blood pressure was too low to measure. Coarse crackling and wheezing were audible in both lung fields. Administration of catecholamine and intra-aortic balloon pumping failed to stabilize the hemodynamic variables, but percutaneous cardiopulmonary support proved to be lifesaving. Coronary arteriography performed during his convalescence showed on evidence of atherosclerosis. The acetylcholine provocation test ultimately revealed a diagnosis of acute myocardial infarction due to vasospasm.