Levodopa-induced myocardial infarction in a patient with Parkinson’s disease and severe coronary artery disease


Levodopa is the most effective medical treatment for Parkinson’s disease (PD) to date. As dopamine is known to increase cardiac inotropism and vasomotor tone, peripheral dopamine decarboxylase inhibitor is coadministered to suppress the peripheral conversion of levodopa to dopamine. Levodopa poses potential cardiovascular risks, thus its use in patients with existing coronary artery disease needs to be carefully monitored. We report a case of an elderly male with newly diagnosed PD who developed non-ST-elevation myocardial infarction following levodopa (Madopar) initiation.

The history of stress hyperglycaemia

Stress hyperglycaemia, is a common phenomenon, frequently associated with adverse outcomes in a number of prevalent conditions including myocardial infarction and stroke. Knowledge on stress hyperglycaemia evolved in tandem with knowledge relating to homeostasis, stress and disease and involved some of the world’s most eminent thinkers. Despite this, it still remains under-recognised.

Contemporary management of coronary heart disease

Coronary heart disease remains the leading cause of mortality in the UK. This review focuses on the contemporary management of patients with acute coronary syndromes and those with stable angina, including the role of primary percutaneous coronary intervention versus fibrinolytic therapy in a UK setting, current and emerging antiplatelet and anticoagulant therapies and the latest guidance on secondary prevention/lifestyle modification.

Paradoxical coronary artery embolism causing acute myocardial infarction in a young woman with factor V Leiden thrombophillia

Paradoxical coronary artery embolism is a rare but under-diagnosed cause of acute myocardial infarction (AMI) and requires a high level of clinical suspicion to make an early diagnosis. We describe the case of a young woman who presented with a severe cough and chest pain who was subsequently found to have a paradoxical embolus in the right coronary artery. Echocardiography showed a patent foramen ovale (PFO) and an atrial septal aneurysm (ASA). The patient was found to be a heterozygous carrier of the factor V Leiden mutation that increases the risk for venous-thromboembolism.