The Case of Myocardial Infarction in a Fifteen-Year-Old Adolescent Caused by Toxic Substances
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The Case of Myocardial Infarction in a Fifteen‑Year‑Old Adolescent Caused by Toxic Substances O. Loskutov1,2 · Yu. Markov1 · B. Todurov2 · O. Druzhyna1,2 · V. Kolesnykov1,2 · S. Maruniak1,2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The article reveals about the clinical accident of myocardial infarction in an adolescent after visiting a night club, where he had been drinking tequila. A "sniper" test was performed at home and showed synthetic marihuana in urine. The uniqueness of this case is the adolescent’s difficult premorbid condition (severe diabetes mellitus type 1 and sub-compensated hypothyreosis) and the clinical course of the disease had caused difficulty in diagnosis which led to a belated hospitalization on the third day. Considering pain syndrome, infarction-like findings in ECG (ST elevation), high levels of cardiospecific enzymes (troponin elevated 70 times, aspartate aminotransferase—two times, creatine phosphokinase—4 times, lactate dehydrogenase and alkaline phosphatase—two times) and their slow tendency to normalize—a non-Q myocardial infarction diagnosis was performed. After complex treatment, the general condition of the patient improved; he was discharged from the clinic in satisfactory general condition and was given recommendations for further rehabilitation. Given the potential for premature death and long-term disability with the development of negative individual and social consequences, the correct diagnostic assessment in such cases becomes particularly relevant. Keywords Myocardial infarction in adolescent · Toxic substances · Infarction-like findings in ECG · Cardiospecific enzymes Abbreviations ALP Alkaline phosphatase AST Aspartate aminotransferase BP Blood pressure CPK-MB Creatine phosphokinase-MB DM Diabetes mellitus ECG Electrocardiography HbA1c Glycated hemoglobin HDL High density lipoprotein HR Hear rate LDH Lactate dehydrogenase LDL Low density lipoprotein MI Myocardial infarction Handling editor: Y. James Kang. * S. Maruniak [email protected] 1
Anesthesiology and Intensive Care Department, P. L. Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
State Institution “Heart Institute Ministry of Health of Ukraine”, Kyiv, Ukraine
2
T3 Triiodothyronine TG Triglycerides
Introduction Cardiovascular diseases cause more than 17.3 million deaths per year and are the leading cause of death worldwide. In 2017, 40,786 cases of myocardial infarction (MI) were registered in Ukraine, out of this number 11853 heart attacks in people of working age [1]. Less than 2% of all acute MI occur in people under 35 years [2]. As far as MI is common in the adult population, it is rare in children. Thus, according to Maslennikova, the prevalence of myocardial ischemia in the population of children and adolescents aged 0 to 18 years is 4.48% [3]. Most cases of acute MI in childhood are secondary to congenital abnormalities or Kawasaki disease (total occlusion of the coronary artery caused by fibromuscular dysplasi
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