Emerging evidence has shown an association between cardiovascular (CV) disease and cancer due to shared risk factors and biological mechanisms especially chronic inflammation. The objective of this case report is to highlight the association between these two lethal diseases and the challenges in the management of coronary artery disease in patients with coexisting malignancy.A 65-year-old nonsmoker, nondiabetic, and normotensive male presented with a history of abdominal pain and significant weight loss. Colonoscopy and biopsy showed adenocarcinoma of the ascending colon, and he was planned for right hemicolectomy. Electrocardiogram exercise stress test performed as a part of preoperative evaluation was strongly positive. Coronary angiography was suggestive of Chronic total occlusion of the left main coronary artery. Though the syntax score was intermediate, coronary artery bypass grafting was decided as the revascularization strategy as he needed early surgery for the colonic malignancy. A month later, he underwent right hemicolectomy.Clinicians should be aware of the association between CV disease and cancer as they are likely to face similar situations where both coexist. Understanding the connections between heart disease and cancer will help to formulate combined preventive guidelines.
Background: Pulmonary Hypertension in mitral valvular heart disease leads to various adverse outcome following surgical treatment of this condition. In majority of the patients this Pulmonary Hypertension is reversible following surgery. The objective of this study is to assess the outcome of changes in Severe Pulmonary Hypertension after Mitral Valve Replacement during the follow up with postop Echocardiogram. Patients and methods: In all our 265 patients who underwent Mitral Valve Replacement Surgery (MVR) for Mitral valvular heart disease with pulmonary hypertension, females 111/195(56.9%) outnumbered the males in this study. 195 among 265 cases had severe PHT. MVR was done with cardiopulmonary bypass using St Jude's medical valve. Results: Despite the high operative mortality in most series of MVR in patients with severe PHT, a striking improvement in survival was noted in the study with 5.3% mortality rate.A sudden drop of PHT is not observed in our study. The fall was found to be gradual and significant over follow up and the maximum reduction was at 1-3 months post operatively. Conclusion: It is concluded that MVR reduces PHT in a gradual way and the mortality rate is also minimum in severe PHT patients. MVR thereby is an effective invasive procedure for the management of patients with severe mitral valve disease and PHT.
The incidence of acute myocardial infarction with nonobstructive coronary arteries in young age less than 20 years in India due to hereditary thrombophilia is uncommon. Combined protein S and protein C deficiency has an increased tendency for coronary artery thrombosis in very young individuals. Acute myocardial infarction in young individuals has different risk factors profile, clinical presentation, and prognosis when compared with elderly population and hence incites the need for different approach in the management. Here we report a case of 17-year-old boy who presented with acute inferior wall myocardial infarction with nonobstructive coronary arteries due to hereditary protein C and protein S deficiency.
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