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Friday, October 9, 2009

Acute Heart Attacks and Sudden Death in Young Adults

I'm consistently amazed when a young adult (< 50 years), presents with an acute MI. I'm even more amazed when its associated with sudden death.
Earlier this week, I took care of a 41 year old thin healthy appearing male who suffered from just this. Luckily he was resuscitated in the field by EMS and I was able to get him to the cath lab quickly and open his blocked artery. He walked out of the hospital 2 days later.
He was not overweight. He did not have high cholesterol. He did not have high blood pressure. He did not have a family history of premature coronary artery disease. He did not use illicit drugs.
So why did this happen to him?
New research may help answer this question. In a paper published recently in JACC, Dr Renu Virmani describes a new mechanism of coronary thrombosis. The general dogma is that the majority of coronary thrombi form as a result of plaque rupture. However, Dr Virmani is reporting that in many patients, especially women and young men, the mechanism underling the thrombus is plaque erosion. In this process, the cells lines the inner surface of the vessel wall are eroded, leaving a raw surface that cause thrombi to form. 
This data may help us in better treating these patients in the future. 
I look forward to more research on this topic. 

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