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. Objective(s). We present the clinical case of a patient (smoker, dyslipidemia, obesity) with diabetes mellitus who developed an acute myocardial infarction managed by coronary angioplasty. Materials and methods. Male, 59 years old, urgently admitted with 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, HbA1c, hematological and biochemical tests. Results. Complaints: angina pectoris and exertional dyspnea at physical effort, headache. Clinical: regular heart sounds, HR 124 bpm, BP 170/95 mmHg, SaO₂ 95%. Paraclinical: ECG: ST elevation in V2–V5, left ventricular hypertrophy, incomplete left anterior fascicular block. EchoCG: apical hypokinesia, EF 45%, moderate PH. Coronary angiography: critical 90% stenosis in LAD. CPK-MB: 25 U/L; Troponin I: 1.35 ng/ml (positive). HbA1c: 8.7%; blood glucose: 13.2 mmol/L; LDL: 165 mg/dL; HDL: 32 mg/dL; TG: 280 mg/dL. Treatment: PCI with implantation of a drug-eluting stent, beta-blockers, ACE inhibitors, antiplatelet agents, statins, 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, resulting in a favorable prognosis.