Page 17 - Journal of Special Operations Medicine - Spring 2015

Special Operations Soldier With Cardiac Family History:
Use of CCTA and Protein Biomarker Testing to
Detect Risk of Heart Attack From Noncalcified Plaque

Millee Singh, DO; Anne Kroman, DO; Julie Singh, MS;
Hassan Tariq, MS; Shetal Amin, MS; Cesar Alberto Morales-Pablon, MD;
Kristina Vanessa Cahill, PA-C; Eric Edward Harrison, MD

ABSTRACT

Objective: We sought to characterize the risk of a heart a heart attack without available medical resources. A
attack in a 48­year­old asymptomatic US Special Op­ large amount of research is being dedicated to estab­
erations Command (SOCOM) Soldier without known lishing new techniques to predict those at risk of sud­
coronary artery disease (CAD). Background: CAD con­ den death or MI. We present the case of an SOF Soldier
tinues to be a leading cause of morbidity and mortal­ without symptoms who was predicted to have a heart
ity among most age groups in the United States. Much attack within 4 days of the event.
research is dedicated to establishing new techniques to
predict myocardial infarction (MI). Methods: Coronary Case Presentation
computed tomography (CT) angiography, also known
as CCTA, along with 7­protein serum biomarker risk A 47­year­old male SOF Soldier presented in the out­
assessment was performed for risk evaluation. Results: patient setting for cardiac risk assessment because of a
A 48­year­old SOCOM Soldier with a family history of family history of heart disease. His father had an MI at
heart disease had skeletal chest pain from war injuries the age of 44. The patient was getting ready to retire
and a 5­fold higher risk of heart attack over the next 5 from the military and needed a preretirement medical
years on the basis of protein markers. A nonobstructive evaluation.
left anterior descending coronary artery (LAD) plaque
with a lipid­rich core and a thin fibrous cap (i.e., vul­ Due to his history of multiple military operation–related
nerable plaque) was detected by CCTA. The patient upper and lower body fractures, such as a left clavicu­
was warned about his risk and prescribed four cardiac lar fracture with misaligned healing, along with cervical
medications and scheduled for angioplasty even though spine injuries with surgical plate­and­screw insertions,
he fell outside the guidelines by not having a severe ob­ he and his physicians established his symptoms to be
structive blockage. Four days later, unfortunately, he referred pain from his injuries.
had a heart attack before starting his medications and
before angioplasty. Conclusion: CCTA with biomarker He denied any pertinent medical history, including car­
testing may have an important role in predicating acute diac risk factors or current medication use. His social
coronary syndrome (ACS) in Special Operations Forces history was negative for tobacco, alcohol, or illicit drug
(SOF) Soldiers with at least one risk factor. Conven­ abuse. He had had a previous exercise treadmill stress
tional stress testing and nuclear scanning would not de­ test in 2010, which was negative for any concerning
tect non–flow­limiting vulnerable plaques in vulnerable abnormalities. An electrocardiogram (ECG) preformed
patients. In order to collect more data, the PROTECT during the initial office visit was also negative for any
Registry has been started to evaluate asymptomatic Sol­ significant abnormalities.
diers with at least one risk factor referred to the clinic by
military physicians. Because of his family history, the patient was recom­
mended for further evaluation with a cardiac CT an­
Keywords: cardiac risk, heart attack, CCTA, risk assessment giogram and an ECG, along with a novel seven­protein
inflammatory biomarker laboratory assessment, which

included a lipid profile. Protein biomarker scores were
calculated using a non–lipid­based algorithm contain­
Introduction
ing four clinical risk factors (age, gender, diabetic sta­
CAD continues to be a leading cause of morbidity and tus, and family history) and seven protein biomarkers
mortality among military men and women in their 40s (CTACK, Eotaxin, Fas ligand, hepatocyte growth fac­
and older. Many initially present with sudden death or tor, interleukin­16, MCP­3, and sFas) produced by the

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