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ACC : Acute and Critical Care



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2 "ST elevation myocardial infarction"
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Original Article
Evaluation of neopterin levels and kynurenine pathway in patients with acute coronary syndrome
Ibrahim Kember, Sonia Sanajou, Bilge Kilicarslan, Gözde Girgin, Terken Baydar
Acute Crit Care. 2023;38(3):325-332.   Published online August 30, 2023
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  • 16 Download
AbstractAbstract PDF
Coronary atherosclerosis is the leading cause of coronary artery disease. Several investigations have indicated that tear-sensitive plaques contain macrophages and T cells. Neopterin is an essential cellular immune response biomarker. The main goal of this study was to see if there were any changes in biomarkers like unconjugated pteridines, neopterin, and biopterin, as well as kynurenine pathway enzymes like indoleamine 2,3-dioxygenase (IDO), which catalyzes the rate-limiting step in tryptophan degradation, in patients with the acute coronary syndrome (ACS) caused by angiographic atherosclerosis.
High-performance liquid chromatography was used to determine the amounts of neopterin, biopterin, and creatinine in urine samples, as well as tryptophan and kynurenine in serum samples. The enzyme-linked immunosorbent assay was used to assess the amounts of neopterin in serum samples. The measured parameters were evaluated between ACS patients and controls.
The measured levels of neopterin, biopterin and the kynurenine to tryptophan ratio reflecting IDO activity, and the specifically known biomarkers such as cardiac troponin, creatine kinase, myoglobin, and natriuretic peptides are statistically higher in ACS patients compared to control subjects. On the other hand, the measured parameters are inadequate to classify the conventional kinds of ACS, ST-elevation- and non-ST-elevation- myocardial infarction.
The study found that determining and using neopterin and IDO parameters as biomarkers in individuals with the ACS can support traditional biomarkers. However, it can be concluded that evaluating pteridine biomarkers solely have no privilege to clinical findings in ACS diagnosis and classification.
Case Report
Acute perimyocarditis mimicking acute myocardial infarction in a 12-year-old boy with duchenne muscular dystrophy
Ho Jung Choi, Hye Won Kwon, Kyung Jin Oh, Mi Kyoung Song
Acute Crit Care. 2022;37(2):258-262.   Published online November 16, 2021
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  • 242 Download
  • 2 Citations
AbstractAbstract PDFSupplementary Material
Differential diagnosis of chest pain in the pediatric population is important but can be challenging. A 12-year-old boy with Duchenne muscular dystrophy presented with chest pain, cardiac enzyme elevation, and convex ST elevations in the inferior leads with reciprocal ST depression in the anterior leads on electrocardiogram. Echocardiography on admission revealed normal left ventricular function. Suspecting acute myocardial infarction, we performed invasive coronary angiography, which revealed normal coronary arteries. A follow-up electrocardiogram showed an acute pericarditis pattern with concave ST elevations in most leads and PR depression, and follow-up echocardiography revealed global left ventricular dysfunction, suggestive of acute perimyocarditis. Ibuprofen was administered for acute pericarditis, and a continuous milrinone infusion was commenced for myocardial dysfunction. The chest pain improved by the next day, and the ST segment elevations normalized on day 4. Echocardiography on day 9 revealed improved left ventricular function. The patient was discharged on day 11, and he is doing well without chest pain through 12 months of follow-up. The last electrocardiogram showed normal sinus rhythm without ST change. Differential diagnosis of acute myocardial infarction and acute perimyocarditis is important for proper treatment strategies and the different prognoses of these two conditions.


Citations to this article as recorded by  
  • Successful treatment of acute myocardial injury of Duchenne muscular dystrophy with steroids: a case report
    Merve Oğuz, Dolunay Gürses, Furkan Ufuk, Münevver Yılmaz, Olcay Güngör
    Journal of Cardiothoracic Surgery.2023;[Epub]     CrossRef
  • Comprehensive cardiac magnetic resonance T1, T2, and extracellular volume mapping to define Duchenne cardiomyopathy
    Sudeep D. Sunthankar, Kristen George-Durrett, Kimberly Crum, James C. Slaughter, Jennifer Kasten, Frank J. Raucci, Larry W. Markham, Jonathan H. Soslow
    Journal of Cardiovascular Magnetic Resonance.2023;[Epub]     CrossRef

ACC : Acute and Critical Care