Intervenční léčba mnohočetných vaskulárních poruch u mladého mužes heterozygotní familiární hypercholesterolémií

Interventional Treatment of Multiple VascularInvolvement in Young Male with HeterozygousFamilial Hypercholesterolemia

We report a case of 31 year old man with heterozygous familial hypercholesterolemia and excessive tobacco useleading to acute myocardial infarction as the first manifestation of premature atherosclerosis. The patvent was treatedby primary PTCA of occluded first marginal artery and at this time an attempt of recanalisation of occluded LADwas unsuccessful. The patient was referred for mini coronary bypass graft of the LIMA to LAD. During evaluationof carotid arteries we found a significant stenosis of the left internal carotid artery and occlusion of the left subclavianartery which made the use of LIMA unsuitable. Therefore, another attempt of PTCA of the occluded LAD wasperformed, this time with success. Hence PTA of the occluded subclavian artery was performed with good result.The patient was treated with the standard therapy of CAD and combined lipid lowering agents with significantreduction of plasma cholesterol. However, 2 years after the first MI, he suddenly died after swimming at the age of31. In this patient the risk of premature CAD was increased by the presence of another powerful risk factor - theexcessive tobacco use. Acute physical exercise probably acted as a trigger of acute coronary events at the time ofboth MI. Interventionalmethods were very effective in the treatment of multiple atherosclerotic lesions in this patientand provided significant relief of symptoms. Treatment of heterozygous FH is briefly discussed in this article.

Klíčová slova:
heterozygous familial hypercholesterolemia, tobacco use, PTCA, PTA, statins, coronary artery diseases,premature atherosclerosis, AMI.