619 Bali Medical Journal 2022; 11(2): 619-627 | doi: 10.15562/bmj.v11i2.3569 CASE REPORT Acute myocardial infarction (AMI) in a patient with Human Immunodefciency Virus infection Starry H. Rampengan 1* , Victor Billy F. Putra Untu 1 1 Department of Cardiology and Vascular Medicine, Universitas Sam Ratulangi, Manado, Indonesia. *Corresponding to: Starry H. Rampengan; Department of Cardiology and Vascular Medicine, Universitas Sam Ratulangi, Manado, Indonesia; starry8888@yahoo.com Received: 2022-05-10 Accepted: 2022-07-02 Published: 2022-07-19 Bali Medical Journal (Bali MedJ) 2022, Volume 11, Number 2: 619-627 P-ISSN.2089-1180, E-ISSN: 2302-2914 Open access: www.balimedicaljournal.org ABSTRACT Keywords: Acute Myocardial Infarction, HIV, STEMI, anti-retroviral therapy. Cite This Article: Rampengan, S.H., Untu, V.B.F.P. 2022. Acute myocardial infarction (AMI) in a patient with Human Immunodefciency Virus infection. Bali Medical Journal 11(2): 619-627. DOI: 10.15562/bmj.v11i2.3569 Introduction: Recent studies have shown that in HIV patients, the incidence of acute myocardial infarction is up to two times higher than in people who are not infected with HIV. HIV patients presenting with the frst episode of the acute coronary syndrome are, on average, a decade younger than the general population, more frequently in men and current smokers. Case Report: We report a case report of a 33-year-old man with a diagnosis of anteroseptal STEMI and recent HIV on frst- line ART, a combination of zidovudine 300 mg and lamivudine 150 mg, plus efavirenz 600 mg. The patient had typical angina complaints and had risk factors, namely smoking and a history of dyslipidemia. Patients were treated according to acute coronary syndrome guidelines, given DAPT, heparinization for fve days, statins, anti-ischemia, ACE-I, and DCA-PCI. The DCA- PCI result in this patient was CAD 1 VD with 1 DES installed in the proximal LAD (complete revascularization). The patient was discharged from the hospital after seven days of treatment. Prognosis in these patients is still quite good, but preventing recurrent myocardial infarction needs risk factors and control for successful myocardial infarction therapy and ART. Conclusion: Special attention should be given to the risk of myocardial in HIV patients. Early diagnosis and prompt treatment could signifcantly lower mortality and improve patients’ quality of life. INTRODUCTION In recent years, there has been an increase in knowledge about cardiovascular diseases associated with the human immunodefciency virus (HIV). Recent studies have shown that in HIV patients, the incidence of acute myocardial infarction is up to two times higher than in people who are not infected with HIV. 1-3 In fact, a cohort study presented the results that HIV patients who did not have risk factors for cardiovascular disease were twice as likely to be infected with HIV. Acute myocardial infarction occurs compared to patients with cardiovascular disease risk factors but without HIV infection. 4 HIV patients presenting with the frst episode of the acute coronary syndrome are, on average, a decade younger than the general population, more frequently in men and current smokers. 5.6 Myocardial infarction is one of the causes of death in HIV patients. Atherosclerosis remains the main basis for the pathogenesis of coronary artery disease in HIV patients, which can lead to myocardial infarction. HIV infection itself plays a role in triggering atherosclerosis through infammatory mechanisms, endothelial dysfunction and coagulation disorders, but this mechanism is not clear. HIV-associated atherosclerosis can be further complicated by antiretroviral therapy (ART), drug abuse, and traditional atherosclerosis risk factors (sedentary life, smoking, obesity, hypertension, dyslipidemia, chronic kidney disease and so on). Te efects of certain ART can lead to dyslipidemia, insulin resistance, and endothelial dysfunction that may contribute to the development of atherosclerosis in HIV patients. 5,7 Current data suggest that the management of myocardial infarction in HIV patients is similar to that of patients without HIV infection. Recent studies have shown no signifcant diference in the rate of revascularization of target vessels afer stent implantation between HIV and non-HIV patients. However, further studies are needed to understand the critical pathways in the pathogenesis of atherosclerosis in HIV patients, the role of aggressive primary and secondary preventive measures for the disease, and the role of current antiretroviral therapy. 5,8 CASE REPORT A male patient with the initials DA, aged 33 years, came to the emergency department with complaints of lef chest pain four days before being admitted to the hospital. Chest pain occurs suddenly when the patient rests for more than 20 minutes. Chest pain felt like a heavy load had been hit, radiated to the lef arm, neck, and jaw and penetrated to the back. Pain does not improve with rest and is accompanied by cold sweats. At that time, the patient did not go to the hospital to seek frst aid and just let the chest pain subside on its own. Afer that, the patient still felt intermittent chest pain with a duration of ± 5 minutes, but it subsided on its own. Four days later, the chest pain reappeared and got worse when the patient was active, so the patient