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Young AMI

Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients. Introduction. Myocardial infarction in persons under the age of 45 years accounts for 6% to 10% of all myocardial infarctions in the United States.In this age group, it is predominantly a disease of men.Unlike older patients, appr

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Young AMI

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    1. Young AMI Ri ???

    2. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Introduction Myocardial infarction in persons under the age of 45 years accounts for 6% to 10% of all myocardial infarctions in the United States. In this age group, it is predominantly a disease of men. Unlike older patients, approximately half of young patients have single-vessel coronary disease, and in up to 20%, the cause is not related to atherosclerosis.

    3. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Coronary Anatomy Most young patients with MI, up to 82% in one study, have typical atherosclerotic coronary artery disease. This manifests more often as single-vessel disease in younger patients than in older patients. However, approximately 20% of young patients with MI do not have atherosclerosis, such as cocaine use or anomalous coronary arteries. Multivessel coronary disease appears to be related to the number of risk factors, especially for DM patients.

    4. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Etiology

    5. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Risk Factors

    6. Atherosclerosis

    7. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Cigarette Smoking Smoking produces endothelial dysfunction and can precipitate coronary spasm. Cigarette smoking appears to be the most common risk factor in young MI patients. The extent of smoking appears to be inversely related to the age at which the first MI occurs.

    8. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Lipid Abnormalities

    9. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Lipid Abnormalities Homozygous familial hypercholesterolemia appears to have the most consistent relation with premature atherosclerosis and MI. Increased TG levels and decreased HDL cholesterol levels have also been reported in MI patients under age 45 years.

    10. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Lipid Abnormalities

    11. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Family History A positive family history of coronary artery disease is a major risk factor for MI in young patients. In an autopsy study of 136 infants under 1 year old, mean luminal narrowing in the left coronary artery was 1.4 times greater in infants with no family history. Increase of the risk in young patients with family history may be due to inherited disorders of lipid metabolism, blood coagulation, or other genetic factors.

    12. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Obesity Obesity, particularly the male pattern of centripetal or visceral fat accumulation, can promote an atherogenic dyslipidemia characterized by elevated TG, a low HDL level, and glucose intolerance. Approximately 30% to 58% of young patients with coronary artery disease are obese, a significantly greater proportion than in older patients.

    13. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Hypertension Hypertension is less common in young MI patients than in older patients. In addition, hypertension is common in patients with left main coronary artery stenosis who are under age 45 years.

    14. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients DM A major feature of elevated cardiovascular risk in patients with type 2 diabetes probably relates to the abnormal lipoprotein profile associated with insulin resistance known as diabetic dyslipidemia. The LDL particles tend to be smaller and denser and thus more atherogenic. DM is also less likely to be associated with MI in young patients than in older patients. Less than 10% of young patients have DM.

    15. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Summary

    16. Non-atherosclerosis 20%

    17. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Cocaine Cocaine blocks the presynaptic reuptake of norepinephrine and dopamine, producing an excess of these neurotransmitters at the site of the postsynaptic receptor. Acutely, cocaine increases heart rate and blood pressure and decreases coronary blood flow through vasospasm, thereby leading to increased myocardial oxygen demand and reduced oxygen supply.

    18. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients

    19. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients

    20. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Cocaine All young patients presenting with symptoms suggestive of myocardial ischemia should be questioned about cocaine use.

    21. Hypercoagulable States

    22. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Hypercoagulable States High levels of factor VII activity or fibrinogen were associated with substantially increased risk of coronary events among men 40 to 64 years old. Use of oral contraceptives, which produce a prothrombotic state, has been an important risk factor for MI in young women.

    23. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Hypercoagulable States Decreased fibrinolytic activity as a result of increased levels of plasminogen activator inhibitor-1(PAI-1) has been reported in MI patients under age 45 years. Deficiencies of the natural anticoagulant proteins, such as protein C, protein S, and antithrombin III are usually associated with venous thromboembolism.

    24. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Hypercoagulable States Elevated plasma homocysteine levels are associated with coronary artery disease, presumably as a result of the effects of homocysteine on endothelial and vascular smooth muscle proliferation. Acquired or inherited platelet disorders have been associated with MI in young patients.

    25. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Coronary Anomalies Congenital coronary artery anomalies account for approximately 4% of MIs in young patients. Several such anomalies, including a deep intramyocardial course, an origin from the wrong coronary sinus, or ostial obstruction, have been associated with MI and sudden death in young patients.

    26. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Others Spontaneous coronary artery dissection Coronary arteritis in vasculitic disorders such as SLE Coronary aneurysms in Kawasaki’s disease Blunt chest trauma causing coronary thrombosis or dissection Mediastinal irradiation therapy for Hodgkin’s disease Valvular abnormalities Embolization from infective endocarditis

    27. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients Prognosis Young patients with MI have a more favorable prognosis than older patients. The incidence of cardiogenic shock, stroke, and left ventricular dysfunction is lower in young patients, probably accounting for their better outcome.

    28. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients

    29. Am J MEd. 1999;107;254-261 Myocardial Infarction in Young Patients

    30. Thank you for your attention

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