Hypertension as a Sole Modifiable Risk Factor in
Young Women with Chronic Total Occlusion
18 Sep 2020, 20:38 Yogi Ramdani Dibaca : 323
Hypertension as a Sole Modifiable Risk Factor in Young Women with Chronic Total Occlusion Coronary Artery: a serial case
Vito Damay, Pintoko Tedjokusumo, Toni M. Aprami
ABSTRACT
Background
Hypertension is a well-established and also a modifiable risk factor for Coronary Artery Disease (CAD). Hypertension alone rarely found as a single modifiable risk factor in young population with severe multi vessel CAD. Younger patients with CAD tend to have single vessel disease and mild luminal irregularities or stenosis. This serial case would warn us the potential burden of uncontrolled chronic hypertension and its consequences to endothelial dysfunction could leading to severe CAD and myocardial infarction.
Case Presentation
We present two patients with chronic total occlusion coronary artery. The first is a 33 years old woman diagnosed as having a Non ST Elevation Myocardial Infarction (NSTEMI). Coronary Angiography then showed a total chronic occlusion in Left Circumflex artery (LCX), a diffuse stenosis 50%-90% in Left Anterior Descending Coronary Artery (LAD) and a total occlusion in Right Coronary Artery (RCA), while Left Main Coronary artery (LMCA) was normal.
The second is a 38 years old woman with chronic heart failure and have no experience of noticeable ischemic symptom. She had a total chronic occlusion in proximal LAD, 70% stenosis in proximal LCX, and 80% stenosis in proximal RCA.Both of the patients had a chronic hypertension, and never took anti-hypertension drugs routinely. They do not have Diabetes Mellitus, abnormal lipid profile or family risk factor. They are not overweight. They are still having periods regularly.
Discussion
Younger patient with CAD tend to have single-vessel disease or mild stenosis (Cole et al). They usually have multiple risk factors that hypothetically could accelerate the atherosclerotic process. Hypertension is an established risk factor for CAD in general but its role seems lesser in young population (Klein et al.). Hypertension is commonly found in combination with other modifiable risk factors in young population with CAD (Noeman et al).
Conclusion
CAD in young female who are still having their menstrual cycle regularly is rare. Despite many novel risk factors arising, hypertension could be found as a sole modifiable risk factor in young and could lead to severe CAD. Clinicians should not underestimate the burden of uncontrolled hypertension.
*Artikel ini disajikan dalam Poster Ilmiah di 7th Scientific Meeting of Indonesian Society of Hypertension, Ritz Carlton Jakarta. Febuari 2013
Pengirim : Vito Damay
ARTICLE