CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 3, May/June 2022 AFRICA 157 Acute coronary syndrome complicated by cardiogenic shock in a young adult: a case report from Dakar, Senegal Serigne Cheikh Tidiane Ndao, Mame Madjiguene Ka, Khadidiatou Dia, Papa Diadie Fall, Mouhamed Cherif Mboup Abstract Coronary artery disease is the leading cause of cardiovascular deaths worldwide. It is becoming a major concern in developing countries, partly due to the adoption of Western lifestyles. It affects young adults as well as older patients over 45 years of age. In this report, we present a case of cardiogenic shock related to myocardial infarction in a young adult. He completed cardiac rehabilitation after the surgery. The outcome was favourable at the six-month follow up. Keywords: acute coronary syndrome, cardiogenic shock, young adult Submitted 7/5/20; accepted 15/8/21 Published online 29/9/21 Cardiovasc J Afr 2022; 33: 157–161 www.cvja.co.za DOI: 10.5830/CVJA-2021-039 Coronary artery disease is the leading cause of death worldwide.1 In younger individuals, there is an increasing incidence of myocardial infarction related to conventional cardiovascular disease risk factors, including hypertension, diabetes mellitus and smoking.2 This phenomenon is becoming a reality in low- and middle-income countries due to epidemiological transition, resulting in part from the adoption of Western lifestyles. The consequences of myocardial infarction can be dramatic in young patients, especially if management is delayed or ineffective. It can negatively affect their productivity for the rest of their lives. We report on a case of cardiogenic shock related to myocardial infarction in a young adult. Case report A 39-year-old man with cardiovascular risk factors of hypertension, which was treated with amlodipine (taken irregularly), active smoking and occasional alcohol consumption was admitted to our intensive care unit for cardiogenic shock. There was no family history of sudden cardiac death or cardiovascular disease. He had reported 10 days earlier with a severe constrictive chest pain lasting for more than 30 minutes, radiating to the back, which was associated with shortness of breath, one episode of haemoptysis and two episodes of vomiting. He was managed initially in his native country (located in the subregion) six days after the onset of symptoms. On examination, the pulse was 108 beats per minute and systolic blood pressure was 70 mmHg with cold and clammy peripheries. There was mild respiratory distress with oxygen saturation of 82% in room air. The jugular venous pressure was elevated with a displaced apex beat. Pansystolic murmur was heard at the tricuspid and mitral valve foci. The rest of the clinical examination were unremarkable. The electrocardiogram (ECG) showed a sinus rhythm with negative T waves in the inferior leads, septal Q waves, ST-segment elevation in V1 and V2 and a Q3T3S1 pattern (Fig. 1). Laboratory testing identified abnormalities, including elevated troponin I level, decreased estimated glomerular filtration rate of 31 ml/min/1.73, blood urea nitrogen level of 161.3 mg/dl and elevated white cell count of 18.67 cells/µl. The D-dimer level was within the normal range and the haemoglobin was 14.3 g/dl. Transthoracic echocardiogram (TTE) highlighted left ventricular (LV) dilatation with an ejection fraction (EF) of 30%, and anteroseptal and anterolateral wall motion abnormalities. It also showed severe mitral and tricuspid regurgitation and pulmonary hypertension (right ventricular systolic pressure 65 mmHg). A chest computed tomography scan was advised to exclude pulmonary embolism and aortic dissection. This was not performed due to renal insufficiency. His medication included high-flow oxygen, enoxaparin, warfarin, atorvastatin and dobutamine infusion. The patient was transferred to our hospital for further management five days later. At admission, his pulse rate was 125 beats/min, blood pressure was 140/90 mmHg on dobutamine infusion, oxygen saturation was 99% while under high-flow oxygen therapy. The physical examination revealed similar findings to the previous one. Cardiology Department, Hôpital Principal de Dakar, Dakar, Senegal Serigne Cheikh Tidiane Ndao, MD, sctndao@gmail.com Mame Madjiguene Ka, MD Khadidiatou Dia, MD Papa Diadie Fall, MD Mouhamed Cherif Mboup, PhD Case Reports
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