Shamkani Warkaa Al, Jafar Nagham Saeed, Narayanan Sunil Roy, Rajappan Anil Kumar
Department of Cardiology, Belhoul Speciality Hospital, Dubai, UAE.
Heart Views. 2015 Jan-Mar;16(1):25-9. doi: 10.4103/1995-705X.152998.
Hyper-homocysteinemia is a risk factor for coronary artery disease in young patients. A 32 years old female without any conventional risk factors except obesity presented with acute anterior wall myocardial infarction (MI). Her echocardiography showed anterior wall hypokinesia with moderate left ventricular dysfunction. Angiography showed tight stenosis of the proximal left anterior descending (LAD) and borderline lesion in left circumflex coronary artery (LCX). She underwent percutaneous coronary intervention (PCI) to LAD with good result. Her blood tests showed low vitamin B12, folate and serum iron levels and elevated serum homocysteine level. She was given folic acid and vitamin B12 and her homocysteine levels normalized. This case demonstrates that hyperhomocysteinemia caused by nutritional deficiency of vitamin co factors may lead to MI. Hyperhomocysteinemia should be considered in the evalauation of young people with MI, especially those without conventional risk factors.
高同型半胱氨酸血症是年轻患者冠状动脉疾病的一个危险因素。一名32岁女性，除肥胖外无任何传统危险因素，出现急性前壁心肌梗死（MI）。她的超声心动图显示前壁运动减弱，左心室功能中度受损。血管造影显示左前降支近端严重狭窄，左旋支冠状动脉有临界病变。她接受了左前降支的经皮冠状动脉介入治疗（PCI），效果良好。她的血液检查显示维生素B12、叶酸和血清铁水平低，血清同型半胱氨酸水平升高。她接受了叶酸和维生素B12治疗，同型半胱氨酸水平恢复正常。该病例表明，维生素辅助因子营养缺乏引起的高同型半胱氨酸血症可能导致心肌梗死。在评估患有心肌梗死的年轻人时，尤其是那些没有传统危险因素的年轻人，应考虑高同型半胱氨酸血症。
