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A year-old man was being admitted to the emergency department with chest pains. He had a history of acute myocardial infarction MI on two prior occasions and was successfully treated with drug eluting stents. He was diagnosed with 3 consecutive events of acute MI in 3 different vessels. The consecutive events of acute MI in different vessels are a very rare case. He did not have risk factors, such as coagulation abnormality, clopidogrel resistance, patient's compliance and vessel abnormality, except for his cigarette smoking. We reported the first case with 3 consecutive events of acute MI in each 3 vessels during a long-term interval. Multivessel myocardial infarction MI is a rare case. Most cases of multivessel MI are simultaneous events and consecutive events of MI usually involving the same vessel. A case with consecutive events of acute MI in different vessels is rare. In addition, patients of consecutive events of acute MI have multiple risk factors or specific underlying diseases. There have been no reports on 3 consecutive events of acute MI in each 3 vessels during a long-term interval. Herein, we report the first case with 3 consecutive events of acute MI in 3 different vessels during a long-term interval. On September 25, , a year-old man visited the emergency room for acute retrosternal squeezing chest pains for the past twelve hours. He had no history of diabetes mellitus, hyperlipidemia, and nor a familial history of coronary artery disease. However, he was a current smoker 30 pack years. He had hypertension and history of two consecutive acute MI. The first acute MI was on February 21, The coronary angiography was performed. The coronary angiography showed a total occlusion with thrombus and Thrombolysis in Myocardial Infarction TIMI 0 distal flow in the proximal portion of the left anterior descending from the coronary artery LAD , which was successfully treated with a bare metal stent 3. In addition, he had taken aspirin mg, atenolol 25 mg, captopril ECG: electrocardiogram. The second acute MI was on December 30, Emergent coronary angiography was performed. The coronary angiography showed total occlusion with thrombus, with TIMI 0 distal flow in the mid portion of the right coronary artery RCA , which was successfully treated with a paclitaxel eluting stent 4. A: the initial coronary angiography shows a total occlusion with thrombus and TIMI 0 distal flow in the mid portion of the RCA white arrow. B: the post stent coronary angiography shows TIMI 3 distal flow in the RCA, which is successfully treated with a paclitaxel eluting stent white arrow. A right anterior oblique view. B: the post stent coronary angiography shows TIMI 3 distal flow in the LAD, which is successfully treated with a zotarolimus eluting stent black arrow and overlapping a sirolimus eluting stent white arrow. He had taken aspirin mg, clopidogrel 75 mg, ramipril 2. He had a regular heart beat and clear heart sounds without murmurs. Echocardiographic evaluation revealed aneurysmal changes at the apicoseptal wall in the left ventricle, and ischemic insult in the LAD and the RCA territory. Emergent coronary angiography showed a total occlusion with thrombus and TIMI 0 distal flow in the proximal portion of the left circumflex coronary artery and collateral flow from RCA, which was successfully treated with a zotarolimus eluting stent 3. After primary percutaneous interventions, the patient became stable without chest pains and was discharged on the fourth hospital day. A left anterior oblique view. A: the initial coronary angiography shows a total occlusion with thrombus and TIMI 0 distal flow in the proximal portion of the LCX white arrow. B: the post stent coronary angiography shows TIMI 3 distal flow in the LCX, which is successfully treated with a zotarolimus eluting stent white arrow. Hematological analyses were performed and showed the following results: D dimer 0. In addition, immunological analyses were performed and indicated the following results: lupus anticoagulant titer 1. He had also been treated with ramipril 2. The patient has been followed-up at the outpatient department without further symptoms. Coronary artery thrombosis is the pathogenic mechanisms of MI. The formation of an intraluminal clot is a result from the loss of integrity of a protective covering over an atherosclerotic plaque. The loss of integrity from the protective covering induces plaque ruptures or erosions. This disruption allows blood to come in contact with the highly thrombogenic contents of the necrotic core of the plaque and luminal thrombosis to occur. There are many risk factors of acute MI, such as cigarettes smoking, hypertension, dyslipidemia, diabetes mellitus, family history of coronary heart diseases, old age, obesity, physical inactivity, and atherogenic diets. Other rare risk factors of acute MI are hyperhomocysteinemia, dysregulated coagulation and fibrinolysis. However, he had no conventional risk factor, except for smoking. There was also no abnormal values for homocystein, coagulation factors, and inflammatory factor. The second MI event was de novo lesion and stent thrombosis. Several factors have been associated with stent thrombosis, including older age, black race, diabetes mellitus, bifurcation lesion, instent restenosis lesion, and other procedure-related factors, such as stent malposition, greater stent length, post-procedure acute renal failure, non-compliance to anti-platelet agent and anti-platelet resistance. Furthermore, we also checked the patient's compliance of medication; he had good compliances. We reviewed other cases of acute MI, including consecutive events or simultaneous events, as well as for same vessels or different vessels. Some cases were reported simultaneously with multi-vessels coronary artery thrombosis. In addition, most patients had multiple risk factors for coronary artery diseases. Acute multiple coronary thromboses may be associated with a systemic prothrombotic condition. Another mechanism is that the first event, causing impairments of other vessel flows, can lead to acute secondary thrombosis. The other mechanism is due to aortic or mitral valve endocarditis. Some cases on consecutive events of acute MI were also reported. The reasons of consecutive acute MI are clopidogrel resistance, 11 anatomical abnormality papillary fibroelastoma 12 , hematologic abnormality antithrombin III deficiency 13 , or other specific underlying diseases. One case was reported with two consecutive events of acute MI in two different vessels during a four-year interval. The patient in the above mentioned case has the Budd-Chiari syndrome and Behcet's disease. There was no reported case for three consecutive events of acute MI in three different vessels during a long-term interval. The evaluation of the causes for consecutive MI attack is important in order to prevent further coronary vascular events which could happen in such manner. However, he did not have risk factors, such as coagulation abnormality, clopidogrel resistance, patient's compliance and vessel abnormality, except for smoking. He has already stopped smoking, thus, there was no correctable factor. So we treated him with triple antiplatelet therapy and planned short term interval follow-ups. Copy and paste a formatted citation from below or use one of the hyperlinks at the bottom to download a file for import into a bibliography manager. Home Archive v. Published online Oct 30, Author information. Author notes. Copyright and License. Tel: , Fax: , Email: hhhsungho naver. Go to:. Myocardial infarction ; Coronary vessels ; Thrombosis. Click for larger image. What is the cut-off value for identifying patients who are low responders to clopidogrel therapy? Thromb J ; PubMed CrossRef. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol ;— Plaque rupture and sudden death related to exertion in men with coronary artery disease. JAMA ;— Stent thrombosis. J Am Coll Cardiol ;— Aspirin and clopidogrel resistance: an emerging clinical entity. Eur Heart J ;— Aspirin and clopidogrel resistance. Mayo Clin Proc ;— Antiplatelet drug 'resistance'. Part 1: mechanisms and clinical measurements. Nat Rev Cardiol ;— Multivessel coronary artery thrombosis. J Invasive Cardiol ;— Falk E. Multiple culprits in acute coronary syndromes: systemic disease calling for systemic treatment. Ital Heart J ;— Acute multivessel coronary artery occlusion: a case report. BMC Res Notes ; Acute and subacute stent thrombosis in a patient with clopidogrel resistance: a case report. Korean Circ J ;— Recurrent myocardial infarction in a patient with papillary fibroelastoma. Arq Bras Cardiol ;e7—e Recurrent myocardial infarction in a young football player with antithrombin III deficiency. Cardiol J ;— Recurrent acute myocardial infarctions and Budd-Chiari syndrome in young woman with Behcet's disease. J Korean Rheum Assoc ;— Publication Types. Case Report. MeSH Terms. Chest Pain. Coronary Vessels. Drug-Eluting Stents. Middle Aged. Risk Factors. Page Views PDF Downloads 3. Links to. Show all Cited by Crossref. Is Cited by the Following Articles in. Citation successfully copied. Permalink information copied to clipboard.

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How can I buy cocaine online in Daejeon

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