Acute myocardial infarction (AMI) due to obstructive coronary artery disease in young patients is an unusual event. Its clinical pattern somewhat differs from that of elderly patients, thus placing them at an increased risk of misdiagnosis, as this young population typically does not demonstrate the traditional risk factors associated with cardiovascular disease. We report the case of a 35-year-old man who presented with newonset chest pain leading to cardiac arrest and was found to have 100% occlusion of the left anterior descending (LAD) coronary artery, which was successfully managed with the placement of a drug-eluting stent. We briefly reviewed the literature and noted that to reduce the risk of dramatic outcomes, it is imperative to include acute MI in the differential diagnosis of young patients presenting with chest pain, regardless of the presence or absence of any identifiable risk factor.
Background Miliary tuberculosis (MTB) is a type of disseminated and active tuberculosis that presents with radiopathologic signs of tuberculous micronodules, as well as microbiologic evidence from detection of Mycobacterium tuberculosis or other Mycobacterium strains in PCR or culture [1]. Case Presentation A 21 year-old student presented with weight loss, fever, cough productive of yellow sputum without hemoptysis, and anorexia of 5 weeks duration. 7 weeks prior to presentation, she had an appendectomy on account of acute appendicitis. Following surgery, there was resolution of symptoms of acute appendicitis. Histopathologic report of the resected appendix showed foci of caseating granulomas. She was immediately commenced on a fixed drug combination of rifampicin, isoniazid, pyrazinamide, and ethambutol for treatment of military tuberculosis and showed clinical and radiologic improvement. Conclusion Miliary tuberculosis following an appendectomy can be due to dissemination of tuberculous foci from the appendix during surgery and surgical stress.
Introduction: Percutaneous coronary intervention (PCI) is associated with an increased risk of cholesterol embolization syndrome (CES), accounting for approximately 70% of iatrogenic cholesterol embolization. The clinical outcomes of patients with acute coronary syndrome (ACS), who develop CES post-PCI is yet to be explored on a national scale. Objectives: To evaluate the length of hospital stay (LOS), cost of hospitalization; proportion of patients with acute kidney injury (AKI), sepsis, cardiogenic shock and in-hospital mortality among those with ACS who develop CES post-PCI. Methods: Adults who had a diagnosis of ACS and PCI done who eventually had CES, were identified from the National In-Patient Sample (NIS) dataset between 2016-2018 using ICD10 codes. Weighted multivariable logistic and linear regression models were used as appropriate. Various sociodemographic, clinical and hospital level factors were adjusted for in the analysis. Results: Of the 365 patients who had ACS and developed CES post-PCI; 48% were women, 76.7% were non-Hispanic White and the average age was 69.5 years. The mean LOS was 8.2 days and the mean cost of hospitalization was $99,958.02. Overall, 32.9% of the patients developed AKI, 6.8% developed sepsis, 4.1% subsequently had cardiogenic shock and 11% had in-hospital mortality. Conclusions: Our study highlights important patient characteristics, resource utilization and clinical outcomes among patients with ACS who develop CES post-PCI, which provides relevant information needed to generate hypothesis linked to this disease condition.
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