unknown hypergoagylability

[TattyJacky]

This is an interesting case that was adressed to our cardiolody department .

a male patient , aged 24ys was admitted with a previously made ECG showin a typical recording of an extensive ant. wall MI


http://rapidshare.com/files/237528794/1.bmp.html

The patient had no fisk factor at all for acute coronary syndromes!! !1

Thrombolytic therapy was given at once and the patient pain was stabilized soon and he was put under close follow up until he was safely discharged.

during his hospital stay period, all the lab results were within normal ranges, even the CPK and cardiac Troponin.


the echo was done with the following report found (( normal LV dimension
borderline systolic dysfunction, EF=50%
marked diastolic dysfunction, reversed E/A ratio
hypokinetic basal mid, apical anterior and anteroseptal segments
LV apical thrombus
mild MR
comment:
IHD with evolving LV remodelling for urgent revascularization.))



coronary angio. was electively done to him and was completely free !!!




the patient was re admitted to our department with a new bout of a typical ischemic chst pain ad his ECG this time was a bit different


http://www.up-00.com/dafiles/JYp87858.jpg

again serial cardiac enzymes was requested and replied with normal values as before


Coagulaion factors V, IX, X, XI & XII were also normal


the rest of the coagulation profile was not requested becoz of unavailability in our labs


anti phospholipid and antd DsDNA were also helpless.





our professors advised him to maintain on anti-platelet (aspirin) and anti-coagulant (warfarin) for prevention of recurrence and decreasing he thrombus extension.



I'm looking forward for any suggestions about what to do in order to precisely diagnose the cause of this hypercoagulable state
kindly note that the patient gave a history of mild gum bleding which occurs with toothbrushing and this case was aggrevated seriously after starting the warfarin therapy. so we did clse follow up to adjust the drug dose and keep a reasonable INR value about 2.2

[TattyJacky]

Thanx for the advice.
i'll put that condition in mind,
i also welcome any other sugessions and help :)

[BrokenPen]

It  is an interesting case, and it starts to increase in incidence. In 2 months we received 6 young males, their ages ranging between 18 and 24 years in the CCU. They were all admitted because of MI. There didn’t seem to be any risk factor, except for one of them who was obese and had high cholesterol levels.

We investigated about the coagulation factors for the 5 others. 4 appeared to have some coagulation disorder while the 5th one was free. We expected hyperhomocysteinemia but didn’t have the necessary materials to investigate about it.

I think u should expect this condition on this patient.