Acute miocardial infarction in a patient with diabetes mellitus, clinical case

Abstract

Background. Diabetes mellitus (DM) is a major cardiovascular risk factor associated with an increased incidence of acute ischemic events, including acute myocardial infarction (AMI). Chronic hyperglycemia contributes to endothelial dysfunction, systemic inflammation, and accelerated coronary atherosclerosis. Recent studies have shown that patients with DM have a 2-4 times higher risk of myocardial infarction compared to the general population. Objective(s). We present the clinical case of a patient with diabetes mellitus who developed an acute myocardial infarction. Materials and methods. Male, 59 years old, urgently admitted with acute coronary syndrome (ACS) to the AMI unit of MCH "Holy Trinity". Medical history: type 2 DM for 12 years, hypertension for 18 years, dyslipidemia, obesity, smoker. Investigations included: ECG, ECHOCG, coronary angiography, chest radiography, cardiac injury biomarkers, glycated hemoglobin (HbA1c), hematological and biochemical tests. Results. Complaints: angina pectoris and exertional dyspnea at minimal physical effort, headache. Clinical findings: regular heart sounds, heart rate (HR) 124 bpm, blood pressure (BP) 170/95 mmHg, oxygen saturation (SaO₂) 95%. Paraclinical findings: ECG: ST-segment elevation in leads V2–V5, left ventricular hypertrophy (LVH), incomplete left anterior fascicular block. Echocardiography: apical hypokinesia, ejection fraction (EF) 45%, moderate pulmonary hypertension (PH). Coronary angiography: critical 90% stenosis in the left anterior descending artery (LAD). Creatine phosphokinase-MB (CPK-MB): 25 U/L; Troponin I: 1.35 ng/ml (positive). HbA1c: 8.7%; blood glucose: 13.2 mmol/L; LDL cholesterol: 165 mg/dL; HDL cholesterol: 32 mg/dL; triglycerides: 280 mg/dL. Treatment: The patient underwent percutaneous coronary intervention (PCI) with implantation of a drug-eluting stent, and was started on beta-blockers, ACE inhibitors, antiplatelet agents, statins, and antidiabetic therapy. Conclusion(s). A smoker and hypertensive patient with diabetes mellitus developed acute myocardial infarction, requiring prompt diagnosis via coronary angiography, which revealed severe atherosclerotic lesions in the LAD. These were successfully managed by coronary angioplasty, Results. ing in a favorable prognosis.