Title : Acknowledging secondary prevention approaches of premature Coronary Artery Disease (CAD) in young woman – A case report
Abstract:
Coronary Artery Disease (CAD) is not exclusively a disorder of middle-aged and elderly individuals; younger individuals may also have premature CAD, which possesses distinct characteristics concerning lipid profiles, risk factors, and clinical manifestations. A case-control study emphasized the significance of atherosclerotic (hypertension, high-fat diet, dyslipidemia) and thrombotic (smoking, low fruit and vegetable consumption, fibrinogen, homocysteine) risk factors in causing premature CAD. In the younger demographic, there exist further disparities in CAD risk factors. Smoking and familial predisposition exhibit a stronger correlation with early coronary artery disease than hypertension and diabetes. Moreover, recent research has shown an increased incidence of Myocardial Infarction (MI) hospitalizations among young women. In the following case, a young female patient had an uncommon presentation of CAD.
Secondary prevention of premature heart disease encompasses strategies designed to mitigate the risk of further cardiovascular events in persons who have already suffered a heart attack, stroke, or other manifestations of heart disease. The primary goals of secondary prevention are to prevent a second heart attack or stroke, halt the progression of heart disease, and improve overall cardiovascular health. Early implementation of these secondary prevention strategies is crucial for improving long-term prognosis and reducing mortality rates.
Case Report: We presented a 58-year-old female patient diagnosed with NSTEMI killip IV very high risk criteria. The patient had a history of smoker, diabetes, hypertension, ischemic stroke, obesity, menopause, and dyspnea on exertion, who was admitted to Saiful Anwar Hospital and diagnosed with Anteroseptal NSTEMI Killip IV. An ECG was conducted, revealing a qs pattern in leads V1-V2, ST elevation in lead V1 (1.5mm), V2 (1mm), and aVR (1mm), as well as ST depression in leads V4-V6, I, and aVL, with no progression in serial ECGs and a reversion to baseline ECG alterations. There was an increase in serial troponin I levels. A 46 mm drug-eluting stent was placed in the proximal-mid left anterior descending artery in a case of coronary artery disease with three-vessel disease. Following a five-day observation period, the patient was discharged. Patient underwent staging PCI and complete revascularization. She educated on preparing for secondary prevention and conducting routine follow-ups.
Conclusion: Management of premature coronary artery disease necessitates thorough patient oversight, assessment of familial history, and regulation of risk factors. Additional inquiry was necessary to examine, from upstream to downstream, all aspects of early coronary disease. This case study emphasizes the importance of secondary prevention of premature coronary artery disease involving strategies aimed at preventing future cardiovascular events focusing on management of modifiable risk factors.
Keywords: Premature Coronary Artery Disease, Young Female, Secondary Prevention.